Medical vs. Dental Insurance: What Covers TMJ Treatment?
If you’re dealing with TMJ pain, one of the first questions people ask is: Will my insurance cover treatment?
The short answer? Almost always medical insurance, not dental insurance.
Why Isn’t TMJ Covered by Dental Insurance?
It seems like TMJ should be a dental issue—it involves your jaw and teeth, after all. But insurance companies don’t see it that way. Dental insurance is designed to cover teeth, gums, and routine oral health care. Things like fillings, crowns, cleanings, and X-rays all fall under dental insurance.
But TMJ is considered a joint and muscle disorder, which means it typically falls under medical insurance—just like treatment for knee pain or back pain would.
What About Bite Splints?
Bite splints are where things get tricky. In my experience:
Medical insurance often covers TMJ treatment but may not cover bite splints.
Dental insurance rarely covers bite splints at all.
Some insurance plans won’t cover bite splints unless they’re treating sleep apnea.
This is where patients run into issues—if a specialist prescribes a bite splint, you may end up paying out of pocket unless your plan specifically covers it, the specialist will be able to find out what your insurance will cover for you.
How Does This Affect Getting TMJ Treatment?
The good news is that physical therapy is almost always covered under medical insurance. If a PT clinic takes your insurance, then you’re good to go—no worrying about whether it falls under medical or dental.
With specialists, it depends. In our area:
Some orofacial pain specialists take insurance for office visits, but their bite splints may not be covered.
Other specialists are entirely out of network—they’ll submit to insurance for you, but you’ll have to use out-of-network benefits, which can mean higher costs.
Bottom Line
If you’re unsure whether your treatment is covered, check your medical insurance first—not your dental insurance.
Physical therapy is one of the easiest and most accessible options for TMJ treatment that’s covered by medical insurance.
If you need a bite splint, be prepared to check your policy closely and ask whether it will be covered.
If you have TMJ pain and need treatment, physical therapy is a great first step—not just because it’s covered, but because it can help address the root of the problem before resorting to more expensive options.
➡ Schedule an appointment and get started with treatment.