TMJ Health Insurance Confusion

Hi there,

I (32, lives in IL) was wondering if anyone can help me. I'm a bit confused on how medical coverage for this kind of thing is supposed to work. My medical insurance is supposed to cover TMJ appliances with pre-authorization.

Basically, the following is what I've done to get this: My dentist diagnosed me with TMJ and sent me to a physical therapist. The physical therapist sent me to another specialist dentist who can fit my nightguard. As my medical insurance requires pre-authorization from my medical doctor for my night guard, I went to my primary care physician, who also diagnosed my TMJ and filled out a pre-authorization form on my behalf, so that I can get this special out of network TMJ night guard that costs thousands of dollars (a normal night guard from my dentist was making things worse.)

However, I need to submit a billing code with my pre-authorization form. I have a dental code for the pre-authorization, as what I need is a dental appliance, but not a medical code at this point.

Will my insurance accept the dental code with the medical doctor's recommendation? What am I supposed to do here? I can't get any answers from them on what they actually cover.

submitted by /u/throwfarandaway234
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