Hi all of my wonderful TMJoiners! I’m Priya Mistry the TMJ doc and today’s video is about
your medical insurance and TMJ Disorder. There is a lot of confusion about insurance
and whether it covers TMJ treatment or whether it does not, so I'm hoping that TMJ coverage
with insurance and I’m hoping this video will help to bring some clarity about this.
Before getting into it, be sure to check my other social media accounts for quick, efficient tips,
trivia, information about TMJD in general. These other accounts also have self massage
techniques that can help bring pain relief almost immediately. So be sure to check those out; I've
linked them all below. For those of you who don’t know me, I’m a general dentist with a practice in
Vancouver, Washington where we are dedicated to taking care of patients with TMJ disorders.
So let’s get right into it. The top two questions I get asked about insurance and
TMJ treatment coverage are: 1) will my medical insurance cover this and
when I say “probably not”, the next question is inevitably “WHY NOT?”
Let’s take these questions one at a time. First and foremost,
with how I treat TMJD at my private practice, medical insurance is what’s
appropriate here - not dental insurance. I am treating and taking care of muscles and
joints, NOT teeth, that's why medical insurance is what's appropriate here.
Now to directly answer the question - Most medical insurances do NOT have TMJ coverage. And that's
how medical insurances refer to it “TMJ”. You can call your medical insurance company and ask
them if you have TMJ coverage under your specific plan. Now depending on who answers the phone, you
may get different responses - this not uncommon. This has literally happened to patients of mine.
Additionally, some plans only TMJ coverage if you're getting surgery. So they have coverage
only for surgical treatment options, and that's only if your medical insurance finds that surgery
medically necessary. At my private practice, we don't do any surgery. I have a 90% success rate
at treating TMJD in a conservative fashion. So back to the question. At my private practice,
I see 12-16 patients a day, 4 days a week, 50 weeks a year. And out of all of those patients,
I've only seen 2 or 3 receive any help at all from their medical insurance.
Those patients MAYBE received anywhere from 1%-10% of their treatment covered
by their medical insurance. For them, the remaining 90-100% is out of pocket.
Which really just brings us to the next question - and that's WHY is TMJD treatment NOT covered
by medical insurance most of the time? Well, my friends, I don’t really have a great answer to
that question. What I do know is there is no standardized curriculum in medical or dental
school teaching how to diagnose and how to treat TMJ problems. Because of this and because of this
just lack of knowledge and lack of education, I think maybe that's why insurance companies just
don't recognize this as as much of a problem or as prevalent of a problem as this truly is.
Statistics show that 30% of the population suffers from TMJ Disorder! My belief is that more than
30% suffer, it's just that that 30% actually got diagnosed. There's more people living with pain,
living with dysfunction and because they're sort of sent on this endless journey of not getting any
answers from their medical providers, it just never really becomes diagnosed. So they don't
factor into that 30% that does become diagnosed with this. So really there's no standardized
curriculum for how to treat this, how to diagnose this. And I got very lucky - I learned what I
know and how to treat this successfully and in a conservative fashion from my wonderful wonderful
mentor, Dr. Arthur L. Parker. Dr. Parker is a dentist - he's retired now. And he sort of went on
his own journey - around the world, really. And he studied renowned osteopaths, renowned TMJ physical
therapists, lots of different practitioners. And he kind of took modalities from each way
of treatment and combined it into how we treat here at my office with a high success rate. So
I was very fortunate to learn from him. So again, I know I'm sort of repeating myself, but because
there's no standardized curriculum for diagnosis, for treatment, I think that this might be part of
the reason why medical insurance companies just don’t really recognize this and offer a lot of
coverage for this. And so that's my sort of best guess at this and sorry I don't have more answers
for you guys. I'm hoping it will change in the future, but we'll just sort of see where it goes.
At my office, we have a very specific way of making care for TMJD - which
can be debilitating - for making that care accessible and affordable. So at my office,
and I don't know how other TMJ Dentists do things, but what we do is that we offer
reasonable payment plans. So we take a certain amount of money down, and we offer payment plans
that can go on basically until the balance is paid off. This makes things accessible for many
of my patients who aren't getting much if any help from insurance at all and really do need
and want treatment and care for the pain and the dysfunction that they are experiencing. With the
monthly payment plans, I’m pretty flexible with how long I allow these to stretch out
because again, I want to make this affordable and accessible. So I feel like I'm pretty flexible,
pretty generous, as long as we're making enough to keep the doors open as well.
Many people will ask why TMJ treatment costs so much? Well, it takes a lot of skill, education,
and experience to know how to treat this condition successfully. Having said that,
I’ve really done my research and I know that my fees are considerably lower than those
across the nation. And I'm not planning to change them drastically because again,
I want to make this affordable and I want to make this accessible for people.
So that’s really it my friends! Be sure to stay tuned because I am
coming out with a video where I will be talking you through the questions
to ask when you call your medical insurance company. So that should be out pretty soon,
hopefully in the next few weeks - so keep an eye out for that video. And again, I’ll be going over
which questions to ask to see if you MAYBE have TMJ coverage through your medical insurance.
Again, I’m Dr. Mistry and I hope you found this video helpful. If so, please feel free to like,
Subscribe, and share with your family and friends! For TMJ pain relief from the comfort
of your own home, please download my free PDF Guide called “3 Steps to TMJ(D) Pain Relief”.
This guide is available on my office website, which I've linked below. As always, questions
and comments are welcome. I'm happy to respond. It's taking me a little longer these days,
so be patient with me. And remember, my friends, you can never have TMI about TMJ! Thank you!