Having TMJ can be a very uncomfortable condition. It can cause everything from minor discomfort to migraines and crippling jaw pain. Recently, there has been talk of the application of Botox to reduce such pain.
Botox works as a muscle relaxant and allows you to lose the tension in the jaw that causes so much discomfort and pain. There are quite a few points to consider on how to get coverage for this treatment.
Does insurance cover Botox treatments for TMJ?
Botox has become one of the allied treatments for the treatment of TMJ. Although its discovery is relatively recent to other therapies, it is increasingly used and recommended.
Because Botox was originally used for cosmetic treatments, there are many disjunctions around the subject. That is why, before answering how to obtain coverage of this type, it is necessary to address this section.
If we speak generally, insurers do not cover Botox treatments for TMJ. It may vary from insurer to insurer, but typically, this treatment is not covered under any policy.
We do not know if this is a legal loophole; as Botox is a cosmetic treatment, insurers should not necessarily cover its use.
The treatment performed with Botox to relieve TMJ is not for cosmetic purposes; that is clear. Even so, the basis of the treatment is still Botox: a material that has always been used for aesthetic and not medical purposes.
Beyond being a legal loophole, it could be due to the distrust of insurers who consider it a high risk to give their clients the possibility of covering the costs of Botox.
It would not be the first occasion in which doctors and patients agree to claim to perform a medical treatment to charge the insurance company for the coverage of the aesthetic medicine.
Can’t Botox be covered as a treatment?
As mentioned above, it is possible to find an insurance company that does cover this type of treatment; although they may be very rare, they do not have to be non-existent.
Therefore, regarding how to obtain coverage for Botox for TMJ, it is necessary to discuss this with the insurer before getting the insurance policy. If the selected insurer cannot offer any policy for Botox, it is best to opt for another one.
It is inconsistent to choose an insurer with no coverage for Botox treatment to improve TMJ in the hope that at some point, they will include it in their policies, and you will be able to opt for coverage of the treatment.
In cases where you already have an insurance company, it is a huge mistake to take the coverage of the treatment for granted for the simple fact that it is for health and not aesthetic purposes.
Before going for a Botox treatment, it is essential to make sure that the insurance company will cover the treatment. You should call and ask if the policy covers this type of expense.
The policy probably does not cover them, and if the affiliate ignores them and does not consult the insurance company before receiving the treatment, they will likely have to pay the expenses themself.
It is necessary to understand that this point is of utmost importance because the average cost of a systematic Botox treatment is $1,500 or more. If the policy does not cover all or part of it, the member must pay the full amount to not ruin their credit life.
Does dental insurance not cover Botox treatment for TMJ?
Here we follow the same premise as in the previous paragraphs: Dental insurance does not usually cover this type of treatment, even with the danger of TMJ to the teeth.
However, due to the increasing amount of research on Botox treatment and its consistent application and success, they are expected to add this treatment to the dental insurance policy soon.
Several dental professionals speculate that Botox will be accepted as a treatment. They expect that dental insurers will begin to consider it in their policies because of its effectiveness.
But, before waiting for a positive response from insurers, approval by the FDA is expected. So far, the FDA has not approved Botox as an official treatment for TMJ.
This lack of FDA approval is another determining factor for insurers not to offer coverage in their policies. Before waiting for insurers to act on the matter, you should wait for a positive reaction and subsequent approval by the FDA. Without it, insurers could maintain their position of 0 coverage for these treatments.
And what about health insurance?
It is here, with health insurance, where there may be a possibility of getting coverage for Botox treatment for TMJ. One of the most frightening consequences of TMJ is migraines.
Due to the constant tension of the jaw muscles, it is quite normal when it results in a severe headache or a migraine. The pain caused by migraines goes beyond a headache. They can be so powerful as to cause sensitivity to light, nausea, and dizziness. A migraine caused by TMJ can be excruciating.
Migraines are considered a medical condition, and if they are suffered as a result of TMJ, and Botox treatment can help alleviate or eliminate them, it is regarded as a medical treatment.
From that point on, it can be covered by insurers. It is not recommended to assume that the insurer will cover it, nor is it urged to think otherwise. When calling to inquire, the migraine problem should be alleged.