Challenges of paying for new treatments

Kaiser Health News published a piece on how many patients with temporomandibular joint disorders (TMJ) pay for treatment out-of-pocket. The article highlights challenges that these patients face, starting with disagreement from medical providers about the most effective treatment for the condition. Beyond that, medical insurers apparently deny some treatment as dental work, while dental insurance view treatment as medical. Even when medical insurance does cover some treatment, the article reports that they might cover the more expensive surgical options but not cover the work of some specialists in this area.

The article reports that the specialty of "orofacial pain" was established in 2020, perhaps explaining the reluctance of some insurers to cover their work. Some who were interviewed point out the irony that insurers are willing to cover more expensive treatment options that are less effective, rather than less invasive options that are supposedly more effective. Understandably, insurers want to avoid paying for ineffective treatment, but as the field of medicine progresses, keeping up with new procedures is likely a challenge.