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 New Patient Documents with Map and Directions     


Points to Consider in Choosing a Provider for TMD Care: 

Surgery is sometimes required in case management.  In most cases this is not the best entry point for TMD care.    

Pain medication is not a solution to the cause of the problem.

Muscle treatment alone does not address the underlying problems with hard tissues.

Dental restorations are not the place to start treating a TMJ problem.   Considering treatment as phases, Phase One is to stabilize the jaw joints.  Phase Two is to restore jaw-based occlusion.  Phase three is dental restoration that is in agreement with the jaw-based occlusion.  

Facts about TMJ Rehabilitation:

It is a somewhat lengthy process that may take several months or longer in some cases.  It is a complex process for the provider, however, it is minimally invasive for the patient.  It just requires time for the joints to adapt.

TMD or TMJ problems is not a diagnosis.  TMD is a wide range of specific problems. 

Treatment has to be in the right sequence to restore the system integrity.  

Referrals for specialized treatment may be needed. 

Although not invasive, the process to rehabilitate the joints is complex to bring the joints, teeth, and muscles to work together again in harmony.

 

Standards of Care: *

1.   Medically sound, orthopedic standards to stabilize the TMJ's.   

2.   Jaw-based occlusion based on well-adapted TM joints.    

3.   Treatment of muscle dysfunction and myofacial pain.

* Not an organized specialty at this time.  We support the standards established by the American Dental Association (ADA), the American Academy of Oral Facial Pain (AAOF), and the TMJ Society of California (TMJSociety.org) and work to establish those standards locally. 

 

TMD Treatment is covered by Medical Insurance

 We are experts at preparing claims, responding to insurance company requests, denials, or issues.  If you speak to your health insurance company here are some guidelines.    

 1.   Pain usually precludes pre-certification on coverage.  Insurers are not allowed to slow down treatment where pain is involved.  Pain usually creates an emergency basis for treatment.  If you have pain, let them know.  the diagnosis thediagnosis is completed you  need to tell them your complaint or symptoms.

2.   Explain that there are no in-network non-surgical TMJ providers.  There are oral surgeons in your area, but surgery on the TM joint is “treatment of last resort.”   State that you don’t want surgery if there are options.  

 3.   If they insist on classifying coverage for Dr. Scott’s services as simply “Out of Network” find out about the coverage, the deductible, how much deductible has been met, and maximum coverage.  We find only a 10% to 20% decrease in coverage verses "in network" rates. 

 4.   If you are told coverage is provided, ask for a pre-authorization number at that time or ask for the name and employee-number of the person with which you have spoken.   Keeping records of all conversations is a good idea.  If they make a statement that affects your coverage that is not spelled out in you benefits handbook, ask for that point in writing.

5.    Some policies specifically exclude TMD treatments for a variety of reasons, but it is the exception.  In 18 states medical insurers have to cover the TM joints if they cover any joints and, of course, they do cover other joints. 

6.   If you are told the TM joints are not covered for treatment by a dentist, we will submit letters stating the legal precedents that say otherwise and we have always prevailed in these cases.  Dentist may diagnose and treat TMD in Tennessee.

7.   .  Even though we are not a discount insurance provider, that is, we are out-of-network, we are exceptional at completing medical  claim forms for our patients.  They are ready to mail.   This takes a great deal of work on our part, but we will provide you with letters, support materials, and amended claims whenever called for to address all questions the insurers may have.  Many of our patients end up with excellent coverage when all is said and done.

8.   We are familiar with most insurers.  The claim form you will mail is complete, up to date and accurate.  We will prepare amended claims for you and provide any documentation they may require.   Simply keep us in-the-loop by sending copies of all correspondence you receive from your insurer.  We provide a great deal of help for patients so they can receive maximum benefits. 

 

End Results:

After insurers have paid on the claims and it looks like all is said and done,  you can ask to have your claim coverage reviewed based on the results of your care.   If you have improved health and are satisfied with your care, share the success with your insurer and ask for a review of your claims.  This will help future patients receive coverage for sound care practices for TMD.