Lone Star State insurance regulators want state-regulated group health carriers in the state to do a better job of complying with the state’s temporomandibular joint mandate.
Texas TMJ law requires state-regulated group health plans that “provide coverage for medically necessary diagnostic or surgical treatment of conditions affecting skeletal joints to provide comparable coverage for diagnostic or surgical treatment” associated with the temporomandibular joints, Texas officials write in Texas Commissioner’s Bulletin #B-0033-09. The temporomandibular joints connect the jaw with the result of the skull.
The Texas department “has received complaints related to the improper denial of coverage and preauthorization requests for medically necessary treatment of conditions affecting the temporomandibular joint,” officials write in the bulletin.
Advocates of the TMJ mandate contend that TMJ problems can cause headaches, fatigue and other debilitating health problems. Critics of the mandate contend that some health care providers are too quick to prescribe aggressive treatment for the condition.