"I'm So Tired of Pain": TMJ Sufferers Lost in Insurance Gap

By: Jessica Zartler Email
By: Jessica Zartler Email

A jaw joint disorder that affects an estimate ten million people is often not covered by insurance and one local woman suffering from the pain it brings says she can't afford the surgery she needs and she doesn't know where to turn.

11 News Reporter Jessica Zartler has more on how a gap in coverage has many people suffering in silence.

"My biggest fear is that i can't handle the pain and I honestly might become suicidal," TMJ sufferer Jill Johnson tells 11 News.

Johnson says not a minute goes by that she isn't in pain. The Clifton resident suffers from a severe case of TMJ, a disorder of the jaw joint.

"I'm so tired of pain," said Johnson.

Pain across her face and jaw from a dislocated right TemporoMandibular join and a left joint that has completely disintegrated from arthrities.

"I just get more and more depressed and I feel desperate for some help."

Help she can't get from her Medicaid insurance.

That doesn't surprise Doctor James Kennedy, a dento–cranial expert who sees patients get rejected for coverage everyday.

"It's sad to see that they're not getting coverage. There are a lot of things in medicine that don't get covered also because they don't fit into the slots that insurance have created for people," Dr. Kennedy told 11 News on Tuesday.

Dr. Kennedy says dental insurance calls TMJ disorders a medical problem and medical says it's dental.

Meanwhile the patients that can't afford thousands of dollars in treatment are stuck with the pain.

"It's ridiculous, I mean they should have coverage," said Kennedy.

He says he tries to help patients with payment plans but some just plain can't pay--people like Jill Johnson.

"I don't have that, i don't have my bills paid," Johnson told 11 News.

She has written hundreds of emails and letters to congressmen and senators to try and change insurance laws.

But until she can get coverage she says she's afraid to eat and afraid to continue to suffer.

"I just really honestly don't want to live like this forever in pain. I'm hoping somebody will come through."

Dr. Kennedy says a proposal in Colorado congress in 2005 was set to address the insurance concern of Johnson and thousand of other TMJ sufferers but that bill died in the legislature and no one has tried to reintroduce the proposal.

He says states such as Minnesota and California have enacted similar measures to ensure coverage for people suffering from TMJ diseases and disorders.

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  • by Jill on Jun 24, 2009 at 09:50 AM
    It certainly is debilitating, Candice. Pain causes great dysfunction, indeed. Please feel free to read the following page (re: http://taotouch.us/TMJ/tmj%20jjamd%20letter.htm) and DO share with friends that we all need paste as many comments as possible on that page, also. Though I am currently exhausted, I am trying very hard to maintain sanity and do what I can to initiate changes to our Federal and State insurance guidelines regarding this issue. Thank You and Best Wishes.
  • by Candice Location: WA State on Jun 23, 2009 at 05:44 PM
    I have the same issues. I live in constant pain from my jaws into cheeks, into ears and head, neck and swelling blocks my air. Something needs to be done about this. TMJ can be classified as both medical and dental because it causes both medical and dental problems and TMJ can also be the result of another underlying pre-existing medical conditon. This is a terrible disease that debilitates.
  • by Jill Johnson Location: Clifton, CO. on May 19, 2009 at 01:37 PM
    Well, to others with similar physical illness, all I can write, at this point, is the question, "Who are the Lawmakers?" After diligently continuing my quest to not only seek help for my/our painful condition and overdue surgeries, but have continued my quest to insure 'Lawmakers' recognize damage to the mandible and the jaw-joint as a Medical condition, I also continue to receive the same response, if any, from all. They wish me luck but offer no guidance as to where I and other patients lacking medical care should turn. Merely, all tell me to “try to write your Congressman, Senators,” or the like. I have! Repeatedly. You name it, folks, I have telephoned, written and or emailed all CO. politicians, 2 Presidents, now, every Medical Institution I can locate, and every Major News Corporation within the U.S. in effort to resolve this issue. All to no avail. I want to say that I, too, wish us all well, and very much wish I could herein write more encouraging news to others. I just cannot.
  • by Mary Location: Dallas, TX on May 7, 2009 at 01:12 PM
    I can only concur with Dr. Kennedy and others who have posted comments on Jill's issue. There must be some relief from her intense pain and poor quality of life she now has due to the problems she is having. A bone is a bone, regardless of where it is positioned in the body. This is crazy! What can we do to make something positive happen for Jill and others who suffer from this particular disorder?!?
  • by Ken Location: Seattle on May 7, 2009 at 01:35 AM
    I watched the short clip and found it very effective in describing the plight of TMJ sufferers. Jill's pain seems like pure agony. Why do we have a health care system that will pay for treating a hangnail but will refuse to treat a person in such agony? This is shameful, America! The system must change. To think of this as a dental malady is folly! Best wishes, Jill....keep up hope; keep up the fight.
  • by Cyndee Location: Oklahoma on May 6, 2009 at 07:36 PM
    The point in this whole thing is not the mainstream insurance that won't pay, but the government run agencies set up to help the lower income people like Jill, that won't pay. Medicare AND Medicaid laws need to be changed to cover those suffering like Jill and stop the picking and choosing who gets care. It is obvious, no one in charge is considering the pain and suffering of those they so quickly exclude from care! Federal Healthcare cuts are what is causing this woman to suffer, daily. It's not that we Americans don't have the Specialists, though perhaps limited in number, that can help her. It's the truism that, with everything we hear and read about the need for Healthcare Reform, Jill is a prime example of what happens with prolonged Medical Care negligence." And...we hear a government wants to take on all healthcare? They have clearly proven though their systems, they have not the skill nor compassion to undertake this task.
  • by JillJ Location: Clifton, CO on May 6, 2009 at 06:25 PM
    Yes. Now IS the time for us to keep hoping such suffrage is no longer ignored. I am fighting suicidal thoughts every day and would write elsewise were it not true. I do wish to share that I am grateful to Jessic, the Reporter, for having the courage and compassion to want to help me. After 18 months of diligent but vain research of the situation in hope of securing surgery, I applaud all with hope yet to help. Among those I applaud and who have offered much encouragement, too, I wish to Thank Dr. Robert Christensen, D.D.S., FAIMBE of TMJ Implants, Inc. and Renee Glass of TMJ JJAMD. So, Thank You, All,for the kindly hopes, words and gestures. I do wish to clarify, however, that it is Medicare, not Medicaid, that is the culprit of much ongoing suffrage. It is Medicare's Dept. of Financing and Policy very much rearing its awful truth, every moment in my world, and I am merely an extreme example of what lack of medical care leads to and why Healthcare Reform is clearly in order.
  • by Kaylan Vialpando Location: Boise, ID on May 6, 2009 at 11:32 AM
    I think that because some people have abused "TMJ" insurance help (not every little jaw pop is in need of treatment), that insurance companies and medicaid have blanketed this issue, where it is much more complicated than that. TMJ pain can be a miserable, constant, disability. When you have extreme cases, such as Jill's, exceptions need to be made to help. I mean, if a joint is MISSING... hello??? If it had been a missing knee joint would she get help? Why is this different? This is beyond occasional jaw popping. Let's get serious here. She needs medical help.
  • by Leslie Location: Portland, Oregon on May 6, 2009 at 08:38 AM
    I think the interview missed the point regarding Jill's insurance, namely Medicare won't cover surgery She has lived in chronic disabling pain for a decade and is feeling the effects of what it is to be an impoverished white American in this country. Isn't it unfortunate our government will pour billions of our tax dollars into saving corporate moguls who have overspent their budgets, but will not consider better health care for the poor less fortunate persons. I am thankful every day for employment which allows my family to afford a personal insurance plan which would cover such a procedure, but pray for those who live their lives in desperation such as Jill. America has lost its compassion! Furthermore I understand there is a specialist, Dr. Christensen from the American Institute of Medical and Biological Engineering who is knowledgeable about the surgery needed and performance of the procedure who was also interviewed but not included in the final news broadcast. That's too
  • by christi Location: grand junction on May 5, 2009 at 06:12 PM
    I also suffer very much from TMJ. i am 35 now and have had it since i was sixteen. i was covered on my mom and dads insurance till i moved out of the house, but afterer i moved out i've had no luck in coverage. i also suffer with terable pain everday.All u can do is live with it, u cant take pain pills for the rest of your life, and you cant aford to get sergery, so wat do you do?? I feel for and with you Jill it is a very hard thing to live with, it takes away from your day to day life. And the head aches, its like having a migrane every day of your life i hate having this and not being able to recieve treatment, cause us people with this do not fit the governments critera . i would trade someone in there posistion any time, and let them go throuhg our pain and suffering, then i bet something would be done!!! Jill if there is anyway i would love to visit with you on this
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