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INSURANCE CONSIDERATIONS FOR TMJ
/ TMD
Insurance coverage
for TMD treatment is unpredictable. Most insurance companies
do not cover TMD treatment. Since dentists treat TMD, it is expected
that treatment is covered by dental insurance. Generally this is
not true. When there is insurance coverage it is usually covered
by the medical insurance company because just like treatment for
other joints and muscles in the body, the TM joint and jaw muscles
are no different.
Insurance coverage
for TMD varies from state to state. In Massachusetts there
is no law that mandates that insurance companies have to cover TMD,
and in fact most do not. When an insurance company covers TMD, there
are usually exclusions such as the amount of money available.
In Massachusetts
HMOs like Tufts, Harvard Pilgrim, and HMO Blue to not cover
conservative treatment for TMD. They do cover surgery, despite the
fact the surgical treatment is more expensive for them compared
to relatively inexpensive conservative treatment. Some Blue Shield
policies that are not HMO Blue may have limited TMD coverage as
do other indemnity insurance companies.
It is wise for you to call
your benefits coordinator at work, or
to speak directly to the patient information center at your insurance
company so you know what to expect by the time you consult with
your doctor.
Overview
of TMJ / TMD | Causes
of TMJ / TMD | Symptoms
of TMJ / TMD
Examination and diagnosis
of TMJ / TMD | Treatments for
TMJ / TMD | Insurance
considerations
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