How Much Does TMJ Treatment in Idaho Falls Cost & Will My Insurance Cover It?

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Due to the complex nature of the cause of TMJ (Temporomandibular Joint) pain and Temporomandibular Joint Disorders (TMD), finding a medical or dental insurance provider that covers the cost of TMJ treatment in Idaho Falls is surprisingly difficult. Because of this, many people who suffer from this often debilitating condition go months or even years without the proper treatment to help reduce or remove pain caused by TMD. It doesn’t need to be this way! There are many options to choose from to pay for your treatment including payment plans, talking to your insurance provider, changing to an insurance provider that includes TMJ treatment and a TMJ treatment center like Comfort Sleep Solutions. If you are currently suffering from TMJ pain, you may be confused about how much treatment will cost you and how it will be covered. This article examines potential costs of TMJ treatment in Idaho Falls (which can vary greatly depending on the severity of your condition) and how insurance may or may not cover your treatment.

 

The Cost Of TMJ

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Treating TMJ pain in Idaho Falls begins with talking to your family physician to rule out some conditions that have similar symptoms as TMJ. Without insurance a visit to a doctor could cost upwards of $150; with some insurance providers, you can expect to pay only $20 out of pocket. Once your doctor has ruled out other possibilities, you may either be diagnosed with TMD or be referred to a dentist for further evaluation. Once you receive the official diagnosis of TMD or TMJ pain, you will be directed to an expert in TMJ treatment in Idaho Falls to for a consultation and treatment analysis. Many businesses will offer a free initial consultation. To schedule your consultation with Comfort Sleep Solutions, contact us today.

After your consultation, a treatment plan will be prescribed to you depending on the severity of your TMJ disorder. This is where the price of TMJ treatment begins to vary significantly. The following is a general overview of what one may expect to pay for TMJ treatment without insurance, according to health.costhelper.com :

  • Cold therapy, pain relievers, and rest- Less than $500
  • Physical Therapy – Can cost anywhere from $50 – $300 per session. Depending on how long and how often a person needs treatment,  physical therapy can cost thousands of dollars over a few months.
  • Stabilization Splint – $1,500 or more.
  • Surgery (not typically recommended) – Can cost anywhere from $5,000 – $7,000 for arthroscopy or $40,000 – $70,000 for a total replacement.

Will My Insurance Cover TMJ Treatment in Idaho Falls?

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If you do have insurance that covers the cost of treatment for TMJ pain in Idaho Falls, your insurance may include prescription drug copays or coinsurance of 10%-50%; however, some medical and dental insurance plans and providers do not cover TMJ or TMD treatment. One of the main reasons that insurance plans, both medical and dental, don’t cover TMJ pain treatment is due in part to the controversial debate about whether or not TMJ disorders are a medical or dental issue. Unfortenualy, another reason that insurance companies are hesitant to cover TMJ treatment is because of the low success rates of TMJ treatment with splints and surgery. TMJHope.com outlines the following steps to find out more about your TMJ disorder coverage:

  1. Call your insurance agency to ask what the limits are (if any) on TMJ disorder coverage. If you don’t have a copy of your benefits, ask for one to be sent to you.
  2. Call dental and medical insurance providers
  3. IMPORTANT: Write down the date, time, the name of the person you talked with, and what they said. If they promise any coverage, have them send you written verification of this coverage.
  4. If you are having a TMJ MRI or CT, ask about obtaining pre-authorization.
  5. If you are considering surgery, ask the surgeon to send your insurance provider a “letter of medical necessity.” This is one of the first steps you can take towards getting coverage for jaw surgery for treating TMJ pain in Idaho Falls.
  6. While waiting for approval, call your state insurance commissioner to ask what coverage must be provided for TMJ treatments within your state.
  7. If you are denied coverage for either TMJ treatment or surgery, ask for the appeal process to be explained to you. Document everything. Additionally, request that the denial of coverage be mailed to you.
  8. Submit your appeal according to their process guidelines. Let your surgeon or the institute, like Comfort Sleep Solutions, where you are getting treatment know what’s happening they may be able to help you throughout the process.
  9. If after the appeal, the insurance company still denies your TMJ treatment or surgery, you have the choice to contact an attorney if you choose to.

Additional questions to ask your insurance company about TMJ treatment in Idaho Falls coverage:

  • Do you cover diagnostic services for TMJ disorder? If so, what is specifically included?
  • Is there a lifetime benefit limit on TMJ disorder treatment or surgery? If so, what are the specific limitations to this benefit?

To speak with Comfort Sleep Solutions about the treatment for TMJ offered, contact us today. We can help you navigate the complicated insurance policies and determine whether or not your insurance will cover your treatment with us.

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