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Conditions and Diseases > TMJ Forum > making state mandate TMJ coverage
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Q: making state mandate TMJ coverage
asked by: edgaras on September 12th, 2008
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There is an interesting article by Cigna about TMJ coverage. They are nice enough to cover TMJ care if medical necessity is determined, or if state mandates it.

How does one go about mandating state to make ins companies cover TMJ care?

http://www.cigna.com/customer_care/healthc are_professional/coverage_positions/medica l/mm_0156_coveragepositioncriteria_tmj_dis order_surgery.pdf
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edgaras
replied on September 12th, 2008
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CIGNA HealthCare covers arthroscopy for TMJ disorder as medically necessary when BOTH of
the following criteria are met:

Pain or significant hypomobility persists despite at least six months of scientifically recognized
noninvasive therapies such as pharmacologic pain control, physical therapy and the use of intraoral
appliances.
• Clinical examination and diagnostic imaging indicate the presence of joint pathology that requires
internal structural modification
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edgaras
replied on September 12th, 2008
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My Insurance
My current, Illinois State Comprehensive Health Insurance,
ICHIP, totally excludes coverage for TMJ.

What can I do?
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edgaras
replied on September 15th, 2008
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OK,. there was a lady here on the board who posted a while ago, I really hope she can provide some insight about the methods she used. She said she went against some commission, and did not give up - the state finally mandated TMJ coverage.
Illinois is pro consumer state, governor has many plans in regards to insurance, so he will be my next office to call. I wish more people would take up this cause. Contacting the Senate might help too.
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