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TMJ/TMD Insurance Coverage

One of the major frustrations TMJ/TMD patients must deal with is trying to get their insurance companies to cover diagnosis and treatment. Medical insurance carries will offen deny payment because TMJ/TMD is a "dental" problem. Dental insurance carriers will likewise, you guessed it, deny payment because TMJ/TMD is a "medical problem."

Most California patients are not aware legislation has been passed to improve TMD care in California. Insurance companies still routinely "deny" coverage that you actually do have. Make sure you read over the policy carefully.

The following is an excerpt from the website of the TMJ Society of California (http://www.tmjsociety.org).

As a direct result of the TMJ Society of California's testimony and efforts, AB 2994 - "The Jaw Joint bill" - became reality for California's consumers in July of 1995, ensuring that denials of surgical treatment for jaw joints or upper/lower jaw bones would constitute a misdemeanor if surgery were determined to be medically necessary. Since passage of AB 2994, such denials of treatment are illegal and considered discriminatory. Viewed as a major victory for sufferers of TMD, the thoroughness of testimony and data presented by the TMJ Society of California was significant -- AB 2994 passed with minimal opposition. Assisting in the review of those cases for which surgical treatment had been determined to be medically necessary, but where as a denial of authorization for insurance benefits prevailed, a "first ever" Peer Review Board was created by the TMJ Society to ensure adherence to the law set for by AB 2994. The board continues as a vital component of the TMJ Society of California today, and is comprised of specialists within the Medical, Dental, Radiological and Physical Therapy professions.

Many insurance companies have "gotten arournd" the above statute by severely limiting the coverage. For example, limiiting lifetime coverage to $2500. If you require extensive treatment this won't get you very far.

You can find information concerning TMJ/TMD insurance coverage in other states at http://www.tmjoints.org/policy/TMJState.htm.