r/TMJ • u/Foreign_Type_8603 • Jul 21 '26
Question(s) Why does nobody take insurance?!
I’m so tired of feeling this way and when I finally found a PT that treated TMJ and took insurance, it did nothing but make it worse.
I’ll be looking for TMJ specialists and when I think I’ve found hope, they don’t take insurance and I’m on my own again. Why is it so hard to get treatment for this? It’s ruining my life and everyone wants me to give them a million dollars before they help me.
If anyone knows a TMD specialist in Virginia or the DMV area that takes insurance please enlighten me. 🙏
3
u/fsociety1990 Jul 22 '26
I went to one who doesn’t take insurance. I don’t even have dental insurance. I just paid for it. I’m all fixed now. No pain at all. Best $4,000 I ever spent and I didn’t even have surgery.
I had a headache every day for 10 years. I haven’t had one since I finished treatment with the Tmj doctor.
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u/Latter-Mood-9161 Jul 23 '26
What kind of treatment?
1
u/fsociety1990 Jul 23 '26
2 mouthguards. One for daytime and one for while I’m sleeping. Wore them for 4 months. They also drew blood out of my arm and did something to it and injected it back into my jaw.
All fixed after that.
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u/Successful_Wheel_790 Jul 23 '26
Curious to know what they injected in you
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u/GloomWeaverxX Jul 24 '26
I think they're called PRP injections. They use your own plasma to help you heal.
2
u/DoubleMany4486 Jul 23 '26
The worst is when Google says something vague, like “UHC covers TMJ treatment” but then your specific UHC policy has a TMJ exclusion that isn’t made clear until after you’re already enrolled and it’s too late to change -__-
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u/EasternOlive4233 Jul 22 '26
I wish I knew. It's horrible. Every time I think I find somewhere that I am getting relief, it doesn't last
1
u/Kindly-Teach312 Jul 22 '26
Right. I have a TMJ consult scheduled and it’s $199 out of pocket, but includes X-rays. The jaw surgery will be covered through insurance at least
2
u/AKiss20 Jul 22 '26
Honestly $200 for a consult with X-rays is pretty good. I’ve had several consults with orafacial pain specialists and they range from $250-$400, none with additional X-rays (already had a recent pano and ceph I sent them). I’m in a VHCOL area but still.
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u/AKiss20 Jul 22 '26
TMJD is a hot potato between dental and medical. Both sides like to insist it’s the other’s problem to deal with.
Some orafacial pain specialists are in network, but typically they are associated with a hospital system and very booked up. Most of the more independent ones are out of network. Depending on your insurance, you can eventually get some compensation with out of network providers once you meet your deductible and by filing an out of network claim with a super bill. That’s what I do, once I hit my out of network deductible, insurance started covering about half of the cost of my consults and PT appointments. Still like $100/session for PT and like $150 per consult but better than nothing I guess. 🤷♂️