You would need to see an oral surgeon. Most TMJ specialists are just dentists and insurance doesn't cover that unless you have dental insurance. This is from my own experience with this. Good luck!

Thank you. I do have a dental plan, but the TMJ specialists don't take ANY insurance (you can submit for reimbursement, but that rarely works for me). I was worried that oral surgeons would jump RIGHT into surgical treatments. Will they explore other options first?

It depends on the doctor. A good one evaluates, tries to ease the symptoms with a mouth guard, maybe physical therapy and some conservative approaches first to see what is going on. At least you would get a better idea of what is happening in your jaw. Surgery should be the last resort. Good luck! I know how difficult this all is. :)

I think insurance denial is routine but this is definately a medical condition and thus makes it so frustrating. I am actually being treated by an orthodontist who "takes a different approach to treating TMJ / DMJ / condylar resorbtion". Mogal splint therapy I think is what we've begun with. I've been to all the others as well. Svaroopa yoga has made the biggest improvement in managing the pain associated with this TMJ but I did not maintain my routine 12 years ago and I'm back at it now. Good luck!

Thank you, Cat. I'll be going to an orthodontist/oral surgeon. It wasn't my first choice (or 10th, or 20th) of practitioners, but it's covered by my insurance and they do deal with TMJ.

I am far from NY but I totally understand the problems you are having with insurance being excepted. I am now with a great Doctor and his office had a person that does the insurance billing, but before I have a procedure I had to pay most of it up front then when they received payment from the insurance they gave my money back. So I am wondering if you might sugest that to them and that way they can do the billing for you and are more apt to be paid by insurance. Also I know that it is called the TMJ but if they could leave those letters out of the dianoses insurance is more willing to pay. For example I am going in and having my left joint totally replaced and the doctors office sent for a pre-approval and it was approved for a Jaw Joint reconstruction surgery. A while back I had to have a CT and my GP put on the orders for a TMJ CT and the insurance denied it, I had to tell them to resumit it for a Jaw joint CT and insurance payed it no problems. Good luck in the future and I hope you find a Doctor that will work with you.

Lilbitz, thanks for the input. I will be very careful about the terminology for my prescribed testing. Great tip! I will ask them to diagnose/bill under terms that are rarely turned down. TMJ is often rejected.

Unfortunately, my insurance has not come through with payments when I submit after the fact with "out of network" practitioners. They are constantly changing their rules, and last I heard they pay a maximum of $25 per session/treatment for anything out of network. That doesn't help with thousands of dollars! My insurance is the worst out there, but I have no choice.

This is why healthcare reform is VITAL in our country. I am American currently living in Germany and let me tell you, our lawmakers in America are LYING to all of you who say that we cannot afford health care for all.
I have TMJ As well and my insurance does cover it BUT like you have all have found out, all of the TMJ dentists/doctors DO NOT take insurance and because they are out of network the insurance reimbursement is almost nothing.
Let's start educating ourselves about true health care reform and actually voting for the people who are willing to make it happen!

I'm SO curious about healthcare in other countries! Floridakris, how is the system in Germany?

Health care in Germany is AMAZING!!!!! Everyone here pays a standard 8% of their paycheck..........you can choose from 70 different healthcare plans. The best part is no matter if you make 10,000 a year or 1 million dollars a year you still pay 8% AND you get the SAME care. Germans feel VERY strongly that everyone should have access to equal care, actually most european countries do and they are all laughing at us American's. They do have private insurance in Germany but LESS than 10% of the population buys it because they have such a good system. It's also much cheaper here and they are very innovative and up to date on the latest medical techniques.
I'm truly sickened at the ignorance of the American people.....I'm so floored that most choose to listen to nice tv ads and actually believe the politicians. People need to fact check and start voting for real change. Health care needs to be a priority and it needs to be available to ALL. I'm pretty floored at the amount of Americans I have met in my life that swear that gov't getting involved with healthcare is a bad idea but then they themselves are on the medicaid/medicare programs, it's laughable.
Ok, anyhow, if you want to do your own research just start with google and do some simple searches for european healthcare or German healthcare or the French system is even better. I also want to let you know that Germany is NOT bankrupt because of the their healthcare system.