What is usually covered?

[StLePf7]

Hi everyone, I am going to see a TMJ specialist for the first time on Friday. I called my insurance company to check on coverage, they do cover the consultation but there was a long list of treatments they won't cover if they are found to be dental in nature. Does anyone know how a dr might find the TMJ issues medical in nature?

[LivingInHope]

Blessed to be of assistance!  How did your appointment go?

[StLePf7]

Thanks, this response was very helpful

[LivingInHope]

You would need to check with your insurance about what is covered in your particular plan.  Often, they will not cover TMJ flat planed splints or bite guards.  They usually will cover a panorex x-ray study of your joints.

  If there is any major inflammation that anti-inflamatory medications taking orally does not alleviate the inflammation in the joint.  Or, if they discover damage to the joint itself, they may also cover things such as an MRI, arthrocentesis, arthroscopy, partial or full joint replacement.  Findings that are medical would include rheumatoid or osteoarthritis in the joint, displaced and/or damaged joint discs, etc..

If you need your teeth re-aligned to get surgery done, they likely will not cover the orthodontic work necessary to prepare/in conjunction to surgery.