Bruxism vs TMD Appliances

Some practitioners think they can enhance both the chance of acceptance and the insurance benefit they will receive by claiming a patient has TMD and are inserting the appropriate orthotic (or NTI)when in actuality the patient is a bruxer and their treatment is a mouthguard.

Nothing could be further from the truth.

First, if a pratitioner is upgrading a diagnosis to receive a larger benefit, then that could be considered fraud.

Second, most dental insurance plans do not cover TMD although they will allow for a habit (bruxing) appliance so the doctor himself is eliminating any chance of a benefit.

Of course, if a patient has a legitimate TMD condition and dental does not cover it, the practitioner should attempt to acquire benefits from the medical carrier.

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