I've had TMJ (jaw joint) problems for half my life, and because of job hopping I've dealt with a lot of health insurance companies. NONE however pay claims for TMJ disorder despite the fact it's not a dental problem- it's a joint problem, like a hip or shoulder! Problem is, you don't see an orthopaedist for your jaw, you see a dentist or other dental-type doctor who specializes in TMJ. And health insurance companies won't accept a claim from a doctor like that. If anyone has any input on how to successfully make a claim and get at least some benefit from my insurance company, let me know. Year after year I pay thousands of dollars out of pocket and get zero reimbursement- despite the fact I'm paying insurance premiums year in and year out! It's not enough of a % of my gross income to deduct from my taxes for some reason, according to my tax advisor.
--------------------
I worked for one of the largest health insurance companies in my state - some of our policies paid for TMJ, some didn't. Just depended on how the employer set up the policy. If your policy has a specific exclusion for TMJ treatment, there isn't much you can do. However, if TMJ is not excluded on your policy, you should be able to get at least some of the bills covered. (Probably not full reimbursement, but something is better than nothing...right?) If I recall correctly, some of the hangups I saw with TMJ claims going through the system tended to be that dentist bill in D-codes. However, your insurance company would likely expect a bill in CPT coding. It might sound silly, but something as simple as using a D-code vs. a CPT code can cause a claim to reject for something that might actually be covered. (The coding info won't do you any good if TMJ is completely excluded from your policy, of course. But it can be an issue if TMJ is not excluded but you're just having trouble getting claims to go through the system.)
Source
No comments:
Post a Comment