My Dental Plan Doesn’t Cover TMD WHY?

My Dental Plan Doesn’t Cover TMD  WHY?

Dental insurance plans do not cover TMD/TMJ issues because it is considered a medical problem. It surely is! There is often joint pain, muscle pain and associated headaches. That is why we always bill your medical insurance plan for that treatment.

Medical insurance plans often respond with:

1. It’s a dental problem and not a medical problem or
2. This treatment is not part of your medical contract or
3. This treatment is excluded from your plan

Yet, if an oral surgeon did an operation, it might be covered, even if the surgery wasn’t really necessary.

If a physician injected steroid into a jaw joint it would be covered.

Both of the above are more invasive.

If your insurance company says it is not covered, find a copy of your insurance contract and look for the exclusion. If it is not there, your treatment should be covered. Often our medical billing team can and will appeal a negative insurance ruling.

There are 2 other issues you should be aware of:

1. The numerical value of your yearly deductible.
2. Whether or not there is a reduced charge if you see a provider out of your network.

It’s a shame that we have to expend so much energy to help you with a real medical problem.