TMJ Disorder – CT scan needed but insurance wont cover
I have had TMJ for several years, but it was limited to some clicking in my jaw until recently, where it has been getting progressively worse over the past two months. I have severe popping and pain in my jaw and cannot open it more than a few inches without pain, cannot eat properly, cannot sleep, suffer from migraines due to this issue. I visited a dentist in-network with my dental plan (MetLife Choice Plus) and they took a panel X-ray showing signs of damage from TMJ.
My dentist recommended a CT scan to get a much clearer view of the entire area, damage that’s been sustained by the joint, position my mandible is in, etc. in order to formulate a plan of care; however, my dental plan will not cover CT scans as they say that is a medical procedure that needs to be handled with health insurance. If I want to do the CT at my dentists office it will cost ~$570 out of pocket (30% coinsurance) which I really can’t afford.
I then contacted my health insurance (UnitedHealthCare PPO) about where I can find a TMJ specialist who can hopefully help me get a CT (only $20 copay when in-network) and treatment, and they tell me that TMJ is not covered under my plan because it’s a dental issue not a health one. My dentist wrote me a referral for the CT scan to an imaging center in-network (UHC) but every imaging center I’ve contacted says they do not take referrals for CT’s from dentists.
So I’m trying to figure out what the heck to do. I need a CT scan (medical procedure) for TMJ (dental issue) and none of my insurances are cooperating because CT’s are not dental procedures and TMJ is apparently not considered a medical issue. I have an idea, but not sure if it makes sense:
Go to an in-network (UHC) family doctor for my yearly physical, which I am due for, and mention to them that I’m having severe jaw pain, headaches, migraines, etc. due to this issue, explain my story so far with my dentist’s recommendation, and request they write me a referral for a CT scan. Even though TMJ treatment isn’t covered under my health plan, maybe the CT would be coded as part of the physical?
I would really appreciate any advice or insight on this issue. For context I am 26m and live in Southern California (92507)
submitted by /u/truthinburritos
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