12 doctors weighed in:

How can I get a TMJ surgery paid for by insurance?

12 doctors weighed in
Dr. Anifat Balogun
ENT - Head & Neck Surgery
8 doctors agree

In brief: TMJ surgery

Your otolaryngologist or oral maxillofacial surgeon will be your best avenue to submit any documentation requested by your insurance company and appeal any denial.
Ultimately if your insurance company decides not to pay, you will need to discuss options with you surgeons.

In brief: TMJ surgery

Your otolaryngologist or oral maxillofacial surgeon will be your best avenue to submit any documentation requested by your insurance company and appeal any denial.
Ultimately if your insurance company decides not to pay, you will need to discuss options with you surgeons.
Dr. Anifat Balogun
Dr. Anifat Balogun
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Dr. Louis Gallia
Surgery - Oral & Maxillofacial
2 doctors agree

In brief: Depends

It depends on your location and your insurance company.
Some states mandate treating the TMJ like any other joint (california). Your surgeon must submit documentation of the diagnosis, imaging studies, evidence of lack of response to previous conservative modalities, and evidence of the problems negatively impacting your quality of life.

In brief: Depends

It depends on your location and your insurance company.
Some states mandate treating the TMJ like any other joint (california). Your surgeon must submit documentation of the diagnosis, imaging studies, evidence of lack of response to previous conservative modalities, and evidence of the problems negatively impacting your quality of life.
Dr. Louis Gallia
Dr. Louis Gallia
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Dr. steven Present
Dentistry
2 doctors agree

In brief: Get involved

The surgeon must write a letter of medical necessity to your insurance carrier. He/she must describe in detail the nature of your specific problem, the procedure he/she is to perform, and your prognosis.
If this is initially denied you can appeal. It may be a good idea to have your employer (assuming they have the contract) get involved and complain if your claim is not approved.

In brief: Get involved

The surgeon must write a letter of medical necessity to your insurance carrier. He/she must describe in detail the nature of your specific problem, the procedure he/she is to perform, and your prognosis.
If this is initially denied you can appeal. It may be a good idea to have your employer (assuming they have the contract) get involved and complain if your claim is not approved.
Dr. steven Present
Dr. steven Present
Thank
1 doctor agrees

In brief: Need consult

You will need a consult and after your examination, I am sure the receptionist at the surgeons will discuss insurance with you.
A predetermination may be required. Also, call your insurance agent.

In brief: Need consult

You will need a consult and after your examination, I am sure the receptionist at the surgeons will discuss insurance with you.
A predetermination may be required. Also, call your insurance agent.
Dr. Jeffrey Bassman
Dr. Jeffrey Bassman
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