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TMJ Disorder -TemporoMandibular Joint Message Board

TMJ Disorder -TemporoMandibular Joint Board Index


Hi all, I have read and read all of your posts and have felt so good knowing that so many others have this problem and have someplace to vent/offer help/and give advice.

I have had tmj for years. I will give just a brief history and get to the current problems. I was diagnosed about 7 years ago and fitted for an occlusional splint that was acrylic. The dentist never could get my bite right on it and I kept telling him it felt like it was going to break in half. Well it did and after it did it felt great and I was symptom free pretty much for several years. I quit going to him had no dental insurance at the time and had paid cash for the splint and other work and was pretty disgusted.......jump to a year ago. I found a new dentist and went basically because of severe pain in some of my teeth. She assured me she was a qualified tmj specialist. I told her about my splint because I was still wearing it everday and she said since it was broken not to worry about new fillings/ crowns fitting under it, she would replace it at the END of my dental work..........

I do have dental insurance I had a TON of dental work done trying to get rid of this pain in my teeth that she so assured me was due to old, cracked fillings, gum disease....on and on.

Well I couldn't wear the old splint after the first new filling and it just spiraled after a year..........I was spending more days in bed in pain and blinding headaches than I was up and about. She made this awful rubber splint ( like you can buy at Wal-Mart ) and charged me $90 and billed my insurance $89!
Of course it didn't work for me at all and after an awful setback I started seeing a new dentist last week. He totally remade the rubber splint to fit my mouth and I went 3 times for an adjustment. I was doing great, but now after 6 symptom free days I am a mess again and going back today.

The new dentist said I need a hard splint, which of course I knew I did, but he checked with my insurance and they said I only get a 1 time LIFETIME benefit where they will pay for 50% of a splint! I mean how can they say that...........they only were billed for $89! The splint I need costs $800!! UGH I am so discouraged, I am going to call them and tell them I will reimburse them the stinking $89 and that way I can use my one time benefit on something that isn't a Wal-Mart splint!
Any help, suggestions, or comforting is well appreciated!

Hi Karen:
For the most part most on this board who have dental insurance have found their insurance companies extremely difficult to deal with and most unwilling to cover the cost of their treatment. Some on the board have got their insurance to pay by their dentists using the code MPD {Myofacial Pain Dysfunction} rather than TMJ. You might ask your dentist to use this as your diagnosis code rather than TMJ. It might help.

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