Not looking for any medical advice...I just kind of need to vent right now.
I have TMJ. It's been an ongoing problem that just keeps getting worse. Every time I open my mouth, my jaw pops and clicks. I grind my teeth and have constant headaches. My dentist wanted to refer me to an orthodontist for braces to correct my bite misalignment but I never made an appointment because my dental insurance doesn't cover orthodontics. He also wants me to get an occlusal guard, which is covered 50% IIRC, but I can't afford the co-pay right now.
Two weeks ago I went to the dentist for a few fillings. After having my mouth stretched open for such a long period of time, my jaw was very sore for a few days. Then I realized that my jaw popping was getting worse, even if I only opened my mouth a little bit. Last week I woke up one day and realized that I could only open my mouth part way; I yawned and my jaw popped out of place and sent a horrible shooting pain up into my ear. I made another appointment with my dentist which was for today.
I am now only able to open my mouth to about an inch between my top and bottom teeth. I basically have to beginning stages of trismus, or lockjaw. Eating solid food is difficult and I'm in pretty constant pain. The dentist talked to me again about getting braces and a mouth guard, that this is not going to just go away on its own, and if not corrected then I'm going to need surgery on my jaw.
He prescribed me an anti-inflammatory to take for the next month, minimum, and gave me some instructions about resting my jaw. I ended up not having the impressions done for the mouth guard because I simply do not have the extra money for the co-pay right now. He was really insistent about the orthodontics referral, and suggested I call my insurance company because this is not for cosmetic purposes.
I called my insurance company, and lo and behold they consider TMJ to be a medical diagnosis, not dental...therefore I have more coverage options! It's very possible that the braces and other treatments would be covered under my medical plan. Even better, I've already met my deductible and out-of-pocket maximum for the year, so it could be covered 100% (so long as I'm treated before Dec 31)! All the dentist has to do is to submit the pre-determination claim under medical and not dental.
So I called my dentist's office and his receptionist/tech acted like I was completely out of my mind and she had never heard of such a thing. She informed me that they do not, under any circumstances, submit any medical claims. She insisted that I must have misunderstood and that my insurance rep meant for me to submit the claim myself for major medical reimbursement. I am not thick, and I wrote down everything the rep told me and read it back to her for confirmation. I didn't argue with her, though; I just said maybe she was right and that I would call my insurance company back and ask for clarification.
I'm going to call the orthodontist he recommended tomorrow (the office was closed today) and hopefully they will understand what I need. I really, really hope so...
I have TMJ. It's been an ongoing problem that just keeps getting worse. Every time I open my mouth, my jaw pops and clicks. I grind my teeth and have constant headaches. My dentist wanted to refer me to an orthodontist for braces to correct my bite misalignment but I never made an appointment because my dental insurance doesn't cover orthodontics. He also wants me to get an occlusal guard, which is covered 50% IIRC, but I can't afford the co-pay right now.
Two weeks ago I went to the dentist for a few fillings. After having my mouth stretched open for such a long period of time, my jaw was very sore for a few days. Then I realized that my jaw popping was getting worse, even if I only opened my mouth a little bit. Last week I woke up one day and realized that I could only open my mouth part way; I yawned and my jaw popped out of place and sent a horrible shooting pain up into my ear. I made another appointment with my dentist which was for today.
I am now only able to open my mouth to about an inch between my top and bottom teeth. I basically have to beginning stages of trismus, or lockjaw. Eating solid food is difficult and I'm in pretty constant pain. The dentist talked to me again about getting braces and a mouth guard, that this is not going to just go away on its own, and if not corrected then I'm going to need surgery on my jaw.
He prescribed me an anti-inflammatory to take for the next month, minimum, and gave me some instructions about resting my jaw. I ended up not having the impressions done for the mouth guard because I simply do not have the extra money for the co-pay right now. He was really insistent about the orthodontics referral, and suggested I call my insurance company because this is not for cosmetic purposes.
I called my insurance company, and lo and behold they consider TMJ to be a medical diagnosis, not dental...therefore I have more coverage options! It's very possible that the braces and other treatments would be covered under my medical plan. Even better, I've already met my deductible and out-of-pocket maximum for the year, so it could be covered 100% (so long as I'm treated before Dec 31)! All the dentist has to do is to submit the pre-determination claim under medical and not dental.
So I called my dentist's office and his receptionist/tech acted like I was completely out of my mind and she had never heard of such a thing. She informed me that they do not, under any circumstances, submit any medical claims. She insisted that I must have misunderstood and that my insurance rep meant for me to submit the claim myself for major medical reimbursement. I am not thick, and I wrote down everything the rep told me and read it back to her for confirmation. I didn't argue with her, though; I just said maybe she was right and that I would call my insurance company back and ask for clarification.
I'm going to call the orthodontist he recommended tomorrow (the office was closed today) and hopefully they will understand what I need. I really, really hope so...
Comment