Is TMJ Covered by Insurance?

Is TMJ Covered by Insurance?

TMJ conditions are incredibly frustrating and painful medical problems. Conditions like these affect our ability to properly use our jaw, causing us pain that can interfere with things as basic and eating and drinking. Fortunately, there are ways to treat the pain and even the root causes of TMJ — but, unfortunately, there are also plenty of peple who suffer from TMJ conditions who are unaware of what problem they face and unsure of whether or not their medical insurance will cover the treatment that they need in order to feel normal again.

What is TMJ?

TMJ stands for temporomandibular joint. That’s a big name, but the definition is simple: the temporomandibular joint is just the joint that connects your jaw to your skull. Your jaw is a separate bone from your skull, of course, which is why you can open your mouth to talk, eat, or drink. But the special joint that makes all of this possible is a delicate thing, and it can suffer from various maladies that we collectively refer to as TMJ conditions, or as temporomandibular disorders (TMDs). TMJ conditions cause pain in and around the joint, and can also cause pain in and otherwise affect the muscles that actually move the TMJ.

If that sounds a little vague, well, that’s because it is: experts say that it can be quite hard to determine the root cause of a TMJ condition. The conditions themselves may manifest with similar symptoms, pain being the most obvious, but they can be sparked by everything from grinding one’s teeth at night to face and jaw injuries that knock the joint out of working order.

Treating TMJ

Fortunately, treating TMJ conditions isn’t quite as difficult as the conditions’ mysterious causes might suggest. Forms of physical therapy may help by strengthening the muscles that operate the TMJ. Exercises that you can do at home can help alleviate the pain (however, you should see a doctor before attempting to “cure” yourself in your free time, of course).

TMJ splints are another treatment option. A bite splint is a custom-made object that patients wear in their mouths in order to set their jaw in a more comfortable and natural position. By finding out where the jaw should be resting and making sure that it actually ends up there, experts can keep patients from creating TMJ pain through poor jaw positioning. The treatment may help alleviate pain in the short-term and, in many cases, can even cure the condition entirely.

Is TMJ covered by insurance?

Everyone wants to feel good, but few of us can afford to ignore the costs of medical care entirely. If you’re considering getting treatment for a TMJ condition, it’s fair to ask: is TMJ covered by insurance?

There’s no short and simple answer, unfortunately. TMJ conditions can be covered by either dental or medical insurance, but TMJ conditions are not among those conditions that insurance providers were ordered to cover under the Affordable Care Act. As a result, TMJ treatments are often excluded by insurers. Fortunately, there are some states that have made their own laws to mandate the coverage of TMJ treatment. These twenty states mandate coverage: Arkansas, Connecticut, Florida, George, Illinois, Kentucky, Maryland, Minnesota, Mississippi, North Carolina, North Dakota, Nebraska, New Mexico, Nevada, Texas, Virginia, Vermont, Washington, Wisconsin, and West Virginia.

If you’re unsure of where you stand, you should speak to your doctor or dentist and to your medical and dental insurance providers to see what your options might be.

Beyond insurance: justice in medical care

Among the many causes of TMJ conditions is injury. If you hurt your jaw in an accident, you could end up saddled with a TMJ condition. That’s especially unfair when the accident in question was caused by someone else’s negligence — but, say workplace injury lawyers in Brisbane, that could also give you another way to pay for your treatment. Workplace injuries or accidents caused by someone else’s negligence may be things that you could be compensated for. If you’re struggling with medical bills following an accident that you believe gave you a TMJ condition, speak to an attorney right away.