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Q: Insurance Coverage
asked by: kedwards75 on April 23rd, 2009
New User
I have had migraine headaches for 20 years (since I was 13). I have been to numerous doctors and had countless tests. My PCP sent me to an oral surgeon because in addition to my headaches I have been having bad pain in my jaw. The oral surgeon diagnosed me as having TMJ. Actually he said that I have a congenital jaw deformity (one side of my jaw stopped growing too soon, or the other kept growing too long). He said that this was classified under the broad "umbrella" of TMJ. This has been causing my headaches for so long. I have developed severe arthritis in my jaw, and have Sleep Apnea as a result (among other things). He prescribed medication (pain med & mild muscle relaxer) neither of which helped. He took a mold of my mouth for a bite guard, but said he doesn't think that's going to help me either. I got a call from my insurance company (Aetna) saying that since I was diagnosed with TMJ they will not cover anything...nothing at all to do with TMJ. Our acct manager said if the oral surgeon coded it as migraines that they might cover it. I am missing 1-3 days of work a month with these debilitating migraines, and now that I know what it is I can't do anything about it because my insurance won't cover it. I don't know what to do. The oral surgeon thinks that surgery would be my best bet, but wants to try all the treatments first. Has anyone had success with the insurance company covering this??
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MTZ28
replied on May 15th, 2009
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Aetna Sucks. I have a ton of health problems that I suspect are related to my really screwed up jaw. I had very poor posture as a child, braces for 4 years from a young age, and got busted in the jaw alot from boxing/kick boxing. This is a serious medical condition and Aetna will not cover it at all. The dental insurance I had at the time would cover $750 per year which is still not nearly enough for me to get treatment any time soon. HOWEVER I just found this information for the state of VA which is where I live: Enacted 1995. The law prohibits insurers from excluding coverage for diagnostic and surgical treatment involving any bone or joint of the head, neck, face, or jaw. It also prohibits insurers from imposing limits more restrictive than those that apply to treatment of any other bone or joint disorder.

There are different laws depending on your state, so hopefully you have a good one and this will help.
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kedwards75
replied on May 15th, 2009
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Thanks!!
Thanks so much for the info. I am also in Virginia, so this is great for me Smile

Thanks again!!

Kristi
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