Insurance Ping Pong Can Aggravate TMJ Pain

If you’re clenching and grinding your teeth more as the stock market tumbles, your angst may get worse when you try to file an insurance claim.

Disorders of the TMJ — the temporomandibular joint that connects the jaw to the skull — affect about 10% of the population, but treatments generally fall between the cracks of insurance coverage. Many medical insurers consider it a dental problem and many dental insurers consider it a medical problem.

Some policies specifically rule out coverage for TMJ disorders. That can be a problem because treatment can get expensive in hurry. The most common remedy is a dental splint or mouth guard that makes it more difficult to grind and clench at night, as I write in my Health Journal column. The kind that are custom-made by dentists who specialize in TMJ disorders run between $300 and $1,800. Insurers seldom pay for them or follow-up visits, which can cost $100 to $250 each.

If your grinding and clenching break a tooth, traditional dental insurance will probably cover the repair. But repair work is usually only reimbursed up to 50% of usual and customary charges. If you’re contemplating surgery on the TMJ joint, be aware that insurers generally require you to have exhausted a long list of other treatments first, and most of those aren’t covered.

Many insurers will pay for physical therapy for TMJ-related problems. And there are lots of diagnostic codes to cover the work. “TMJ patients have so many comorbidities–neck and shoulder pain, headaches, limited range of motion–there’s a slew of things that go along with it,” says Mark Strickland, a certified craniofacial therapist who runs Strickland PhysioTherapy Associates in Austin, Texas. “We address them all.”