TMJ Treatment ALF appliance pain The Case of Too Many Circling the Airport Frederic C81 Flickr cc credit
In our office at Sleep and TMJ Therapy, we are finding that there is a little problem starting. As many of you dear readers already have learned, the insurance companies have quite nicely taken control and are now denying needed surgeries and final braces or crowns, or whatevers, to finish your case and be done with me. What this means is that more and more of my patients are never going to be finished with me and will forever be wearing appliances to ‘maintain’ their position of reduced pain. I truly DO NOT want this! I want you to be able to finish up with me and go about your life, I really don’t want you stuck with me forever!  As Dr. Stack used to say, it would be great to finish up so you are not “stuck to a health care provider”.

Now don’t get me wrong, I truly love working with all our patients, but since we are able to help more than 80% (my team says 90%) get better, this means that more and more are going to continue wearing one or two appliances for a long time to come because the insurance carrier will not pay for them to finish treatment properly. In other words, once the patient is better while wearing their appliance(s), there is usually no insurance coverage for either the surgery or the braces to finish up their case. What a shame. Because of this, many of my patients will forever wear their devices to stay free of the past pain they suffered and I will forever have to maintain them. It’s like a plane circling the airport forever – it just needs a bit of fuel (in my case the appliance needs periodic adjustments) to stay there.

Already, I have had a few people worry because their family might be moving to Arizona or Timbuktu, and they are not sure how to keep up with the maintenance. Some people hope their appliances will last forever- and I’ve already seen several that are 10 years old -but that is not likely. So why won’t the insurance companies just pay for the microsurgery and be done with the problem? It’s all about money- surgery costs much more than the premiums paid, so if they ‘cover’ too many people, it cuts corporate profits. There, I said it- it’s all about money and NOT about taking care of you, the patient! What this approach to corporate profits has done is to shift the burden of care and payment to both me and the patient. You see, I will not abandon my patients, dear readers, and when someone is in ‘forever maintenance’ with me, and they break their device(s), I make new ones at a huge discount- YUP, the insurance companies have now stuck it to me and they are probably laughing all the way to the bank.

So what do we do?  I am not really sure. I have made my own patients aware of this problem, and asked them to talk to their HR directors, but it does not seem to matter. The insurance companies have decided to not pay for TMJ treatment and have transferred that responsibility back to the patient, and to me as well. Still- I won’t go down without a fight – I will always keep making my patients aware and always ask them to keep the fight going.