Question:
In light of recent discussions about HMOs and topics related to the costs
of dental care, it seems appropriate for this newsgroup to discuss the
**extreme expenses** of surgical management of the temporomandibular
joints since this involves the oral-maxillofacial surgeons. I have not
read any posts about the costs involved in this type of care and how it
affects the patients, the surgeons, the hospitals, related health care
providers, health and dental insurance companies, the family unit, and
society in general. (And any others affected).
Answer:
Please take a look at the following WWW html of the American Dental Association:
http://www.ada.org/stateleg/tmj.html
The last paragraph in this particular State Legislative Report states:
"Meanwhile, North Dakota, which enacted a TMJ law in 1989, has amended it
to increase lifetime benefits to $10,000 per person for surgical and
$2,500 for nonsurgical treatment. Previous limits were $8,000 and
$2,000."
Does anyone know if this law is regarding dental or medical insurance?
Does anyone know what kind of TMJ surgical treatment a person can get for
$10,000? Or, how many surgeries a person can get in a lifetime for
$10,000?
Because these figures are so far from keeping with the real world, this is
just one example of why this topic should be discussed openly in this
newsgroup. I hope there will be others who understand this too.
My TMJ problem is being covered under my major medical insurance. My
medical and dental are combined, but they consider TMJ a medical
problem, not a dental problem. I have an Exclusive Provider
Orgainization type insurance. They are encouraging non-surgical
treatments -- bite plates, anti-inflamitories, physical therapy,
othrodontia, etc. It is covered at $1000 per year.
My husbands insurance does not cover it at all -- neither the medical
nor the dental. The plan explicitely states that it is not covered in
any way, shape, or form. I can, however, get the orthodontia covered
at $1000 per year as long as I don't claim that it is to correct a TMJ
problem. This is truly stupid!
What is truly stupid is that the TMJ is not unlike every other joint in
your body. If you needed Knee surgery. It's covered. Wrist. You becha.
But put a couple of teeth three inches from a synchondrosis, and whammo,
there's your exclusion in the fine print.
We don't need healthcare reform in this country, we need insurance
reform!
