TMJ is a potentially disabling jaw condition. Although it may initially be relatively mild, if left untreated it can progress to result in serious pain or even complete immobility of the jaw. From some standpoints, it’s actually no different from other joint problems, except in the eyes in insurance.
To insurance, the temporomandibular joint and its disorders are considered completely separate from other types of joint problems, and, unfortunately, most insurance companies refuse to cover them, unless the state mandates coverage. And, unfortunately, Colorado is not one of the states that mandates coverage of TMJ treatment.
But that doesn’t mean that your insurance definitely doesn’t cover TMJ treatment, just that it probably doesn’t.
What TMJ Insurance Covers
If you’re lucky enough to have insurance that covers TMJ treatment, here’s what would typically be covered:
- Bite splints and oral appliances are usually covered for 6 months (long-term treatment is considered “investigational”), but usually only for jaw pain and related problems, not headaches
- Physical therapy
- Cognitive therapy, relaxation therapy, and biofeedback
- Manipulation for reduction of fracture or dislocation
- Non-opiate painkillers and non-steroidal anti-inflammatory drugs (NSAIDs)
- Some surgical procedures, including:
- Joint replacement
- Cartilage and other tissue grafts
- Meniscus or disc repositioning
In order to get coverage for your condition, you will typically have to meet certain objective diagnostic criteria, which is one reason why we use a CT scan to help us with our diagnosis: it provides documentation that not only helps with ensuring accurate treatment, but may help get compensation from insurance.
Check for Coverage First
Pain and disability makes us think that our condition is serious and should be covered under our health insurance, but, unfortunately, that is not always the standard that insurance companies use.
To insurance companies, coverage guidelines are strict rules that have little if anything to do with the severity of your condition. Before you decide to have any TMJ treatment, it’s best to check with your insurance company to find out if it will be covered or not. Of course, for many of us, treatment of TMJ remains “medically necessary,” whether the insurance company agrees or not.
We can help you determine what TMJ treatments are necessary and whether they may be covered by your insurance. Please call (303) 691-0267 for an appointment with Denver TMJ dentist Dr. Kevin Berry at the TMJ Therapy and Sleep Center of Colorado.