Bruxism Appliances and Dental Insurance
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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posted by Dr J Webb @ 4:21 AM
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