Is a TMJ specialist covered by my insurance? — Marcus
When you’re in pain, it’s unfortunate that most of us have to worry about how cost will dictate a method of treatment, or if you even decide to get specialized treatment. If it was simple, we would all just be able to see who we want and be on the road to a pain free life. But, it’s not that simple. And, if you have seen many TMJ “specialists” in the past, it’s important to remember that while those doctors may market themselves that way, there really is not a true, recognized TMJ specialty.
There are many types of recommended treatment. Conservative methods such as relaxation techniques, medications, or night guards are more common with many dentists and much more widely accepted when it comes to insurance (night guards are covered with a report by the dentist saying it’s for Bruxism, or grinding). On the other end of the spectrum, there are dentists who call themselves “neuromuscular dentists” (usually LVI trained) who skip the night guard all together and go for Transcutaneous electrical nerve stimulation (TENS) which uses a low-level electrical current to relax facial muscles in combination with an orthotic device to find the optimal position for your jaw, by detecting your malocclusion and then making a treatment plan to correct your bite. Plan to pay out of pocket a least a few thousand dollars for this because it is not a covered benefit. Then there is bite correction. Crowns, composites, and possibly orthodontics can be recommended for that. You’ll pay at least 50% of crown work and orthodontics, if you have coverage for that.
Always check your coverage before undergoing any TMJ treatment because most insurance plans do not have TMJ coverage. Paying more doesn’t always mean that you will get better results, so first try more conservative treatments and make some changes in your diet, exercise and stress relief. All those things can make a measurable difference and you definitely don’t need insurance for that.