As someone who has suffered from the debilitating effects of TMD (Temporomandibular Disorder), I can tell you that finding the needed care was like jumping through hoops of frustration straight into a pit of debt. Unfortunately, many people with TMD will often forego the necessary treatment to prevent it from becoming a chronic unmanageable condition due to the out-of-pocket costs involved. 

Did you know that based on information provided by the American Dental Association, only 20 states currently have laws, regulations, or directives related to dental coverage for TMJ disorders. The requirements of these laws differ among states – some require full coverage for TMJ disorder, while others mandate that coverage be offered on certain plans. Unfortunately, this can leave patients and dentists frustrated when trying to treat unmanaged TMJ before it becomes a chronic, debilitating condition in states that do not require coverage for TMJ or the jaw joint in general. 

It was 2006 when I was diagnosed with TMD, following jaw muscle spasms, pain in the jaw, and strange popping noises.Since I was new to the world of jaw disorders, I felt that the ER was the place to go! Of course, as soon as I showed up I received a lot of side-ways glances and confused looks on what I expected them to do to help. I had no idea either! Instead, they instructed me to see my family dentist. 

During my first visit with my dentist, he did his absolute best to try and treat me, despite the fact that he didn’t specialize in the treatment of TMD. He created a hard plastic bite block that fit just over my two front teeth to help prevent grinding my teeth at night. This was well before the amazing customized oral devices that dental practices now have access to. 

Little did I know, a well meaning, but untrained dental professional who didn’t have the knowledge of how to treat TMD patients could do more harm than good, and I quickly found out that neither medical insurance nor dental insurance would cover the treatment that involved the jaw if the dental practice wasn’t well versed in billing medical insurance. I was left with thousands in out of pocket expenses, leaving me hesitant to follow through with available treatment options or to find a specialist who specializes in TMD. I gave up, as many TMD patients do, partly due to frustration and mostly due to the burden of cost that my wallet would see if I continued to get treatment for my jaw. 

Fast forward to the infamous year of 2020, I had spent years treating my TMD symptoms at home with Tylenol, Ibuprofen, and microwavable heat packs when it acted up (Microwavable heat packs are a lifesaver!), and thought I had a handle on the troubles that my jaw would put me through, I was wrong. I had what is called an open lock while eating. I could feel my jaw lock open, and nothing I did was getting it to close. This is perhaps the most terrifying experience for someone who suffers from jaw issues (especially the first time!), after a few moments, I was able to relax my jaw and wiggle it back into place. I thought that was a fluke, but I was wrong, very very wrong. Did you know that when your jaw slips out of place, locks open or closed, or has a catastrophic failure that a relapse can happen for up to 6 months after? I quickly found this out after I woke up with an open lock, after being sound asleep for hours, and had that familiar rush of panic. 

The next morning, I found myself searching “TMJ Dentists” and found a local practitioner who was able to see me immediately on an emergency basis, and though she found that my condition was far too advanced for her to handle, she got me in touch with a local Maxophillio surgeon who was able to take on my care. Through the care under the skilled hands of a Maxophillio surgeon we moved through the least invasive procedures first. 

We tried muscle relaxants, massage, and even botox (It’s not just for beauty anymore!). Unfortunately, while the botox did help for a time, there was something wrong. After an extreme open-lock that required me to be put under anesthesia so that he could perform a manual reduction to get my jaw back in place, he soon ordered an MRI. The MRI found that there was a disc displacement, and though arthrocentesis and a custom bite device was required to adequately start treatment, the cost was going to be to great, so I resigned myself to my “new normal” of eating small bites, pureed foods, or liquids for the foreseeable future. 

Enter medical billing, even in a state that does not mandate the coverage of TMD or jaw related issues. While Dental insurance may sometimes cover some of the costs of TMD, the amount of lifetime coverage can be insufficient for the treatment that is required, leaving patients with extreme out of pocket costs that leaves them in a position of finding self-help home remedies that may make their condition worse over time. 

Fortunately, when a dental provider can prove medical necessity and understands how to use the appropriate codes for the treatment of TMD or jaw disorders, it is possible to get medical insurance to cover the treatment, even in states where insurers are allowed to deny coverage for non-necessary treatments.

While implementing medical billing for dentistry can seem difficult at first, it is an important step in keeping every patient in your practice healthy, happy, and confident that you have their best interest in mind. Our team of professional billers and support are taking the dental world by storm, helping dental practices bill medical insurance for TMD treatments and other medically necessary procedures that would otherwise be hard for patients to afford. 

Remember dentistry deserves to be considered just as important as medical care, billing it to medical insurance helps to build long lasting relationships with patients. Do your patients a favor by seeing how medical billing could save your patients thousands on the treatment of TMD, all while reaping the rewards of more patients saying yes to treatment! Learn more by taking our assessment or scheduling a call with our knowledgeable staff today!