Why isnt tmj covered by insurance

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. We can help you determine what TMJ treatments are necessary and whether they may be covered by your insurance.

If you want more help or are a member of dentalmedicalbilling. You must be logged in to post a comment. Skip to content. The insurer will list the services considered medically necessary with a diagnosis of TMD as well as the services that are not in the medical policy for treatment of temporomandibular disorders, so check the medical policy when you begin working with a new medical insurer. Most insurers will require an actual TMD diagnosis for these services to be covered when the claim is filed…..

Previous Previous. A member of the team will then have a discussion with you about any anticipated or estimated out-of-pocket expenses that remain after your insurance benefits have been applied to your account.

Keep in mind that an insurance authorization is not necessarily a guarantee of payment, so patients should be prepared for the small possibility that insurance will not cover the service. This is very rare, though, and should an insurance issue a denial for a previously pre-authorized procedure, our staff will work diligently to sort out the issue. We will also prioritize communication with the patient regarding any updates on the coverage.