tmj and insurance

Discussion in 'Fibromyalgia Main Forum' started by chp1298, Sep 20, 2005.

  1. chp1298

    chp1298 New Member

    My Denstist and PCP are referring me to specialists for TMJ. My dental insurance will not cover but my medical will. Problem is all the specialists at Duke acccept dental insurance but not the medical. They say they will file dental codes on insurance. So CIgna says that my PCP can call and auth and MIGHT be able to transfer codes to medical so they will pay. Now I dont know what to do because I cant afford out of pocket. This DR is 100 miles away and the closes TMJ doc around. The ONLY one that does the nerve blcks that I so desperately want to try.
    This TMJ insurance stuff is a real pain.
  2. fivesue

    fivesue New Member

  3. ilovecats94

    ilovecats94 New Member

    My famil doc decided in July to not accept our PPO insurance anymore. Well we didn't know anything about it until I got sick on Saturday morning and needed to go there.

    We ended up paying $101 out of our pocket for the OV and lab tests. I had a bladder infection, blood in urine and fever. Have to go back for recheck on 9/30. Who knows how much that will be?

    My doc takes Cigna HMO, but we have heard bad things about that company.
    We may stay with our present insurance and just go with out of network for our family docs who we don't see much. We get a lot of Rx's from them though.

    We also have dental insurance which is separate and different insurance company from health insurance. I know what you are going through, but I don't know what to tell you to do.

    Also with our present PPO insurance we don't need to get any referrals, which I like since I have to see an endocrinologist every 3 months and hubby has to see eye doc every 6 months.

    I wish I could give you some advice about what to do. Insurances can cause so many problems. Just doesn't seem worth it. I can't change famil docs because I'm getting pain meds finally and have been on Xanax (3 a day) since 1997. We are in a rock and a hard place too. I have FMS.

    Hope someone else will offer you some advice about what to do. I'm so sorry you are going through this.

  4. cjcookie

    cjcookie New Member

    an oral surgeon did all the work. I think it was paid for through medical though. Sorry I can't be more help.
  5. tngirl

    tngirl New Member

    Mine was filed on my medical insurance and they paid everything but my copays. I pay $25 per specialist visit. They paid 100% of the MAC. He is an oral surgeon.

    I believe you can file the insurance claim instead of the dentist. There should also be a customer service phone number to call for your insurance. Try explaining the problem and seeing what they will do and how they advise you.

    I called and asked mine and they were very helpful. I did have a handbook, but I wanted to make sure I understood it correctly.

    My policy would only pay for doctors evaluation and doctors visits and bite guard. It would have also paid for braces if that was needed for treatment, but you had to get prior approval for that.