What Do TMJ Treatments Cost?
There are no standardized costs for TMJ treatments. Costs vary by provider and state/country. Treatment costs can range from several hundred dollars to hundreds of thousands of dollars.
Insurance reimbursement for TMJ treatments can be complex and difficult to navigate. Insurance coverage varies from state to state, company to company, and policy to policy. Some policies have specific exclusion clauses for TMJ treatment and some have limitations on the dollar amount or type of coverage available (e.g., only covering surgical procedures). Insurance companies generally do not include TMJ coverage unless mandated by states or at the request of company benefit coordinators because:
- There is much controversy about the causes and proper treatment of the problem.
- There is little scientific evidence demonstrating safety and effectiveness of therapies for TMJ disorders.
Some treatments even appear to cause new TMJ problems or exacerbate existing ones.
What to Do if Your Claim is Denied?
Our recommendation is that you first speak to your benefits coordinator. He/she give you advice on the right person to contact at your insurance company. Take careful notes on the conversations you have with your insurers and health care professionals. Include names, dates and complete descriptions of your discussions.
If after speaking with your insurance company’s customer service department you are not granted coverage, ask for a claims supervisor. If that is not effective, search your health and dental plans for information on the appeals process. Appeals are not easy, but they might be the best way for you to get coverage. If need be, consult an attorney who specializes in this area.
Advocating for Safe and Effective Treatments
The TMJ Association advocates for quality clinical and basic research so that insurance companies can be assured that the treatments they pay for will not contribute to the problem but will actually be proven safe and effective. Learn more about helping us advocate for the needs of TMJ patients here.