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Dentistry/Types of crowns (zirconium and insurance)

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Hi Dr. Teig,

I recently went to my dentist because a filling on one of my upper teeth (#13?) fell out (apparently, due to decay underneath the filling). Long story short, she ended up having to do a crown. I have never had a crown before, and didn't know about the options available (but my insurance does cover some types of crowns). I found out after paying, that my dentist ordered a zirconium crown without consulting me and my insurance did not cover any of the cost (so I ended up paying $995 out of pocket for the services - $895 of that being the crown). As I have never had a crown before, and didn't know the average cost (or have the schedule of services from my insurance in front of me), I didn't think to ask about the type of crown she was using. Otherwise, if she had chosen a crown within my coverage (i.e., presented me with my options), it would have been around $500 for all the services (my out of pocket for a crown within my coverage would be $410).

Right now I've contacted my insurance company and they are contacting the dental office to get confirmation of what crown they ordered and see if it can be covered. My first question: I see under my insurance that they have a billing category for Crown—porcelain/ceramic substrate (as well as resin fused to metal and porcelain fused to metal type crowns). Could a zirconium crown fall under this 'ceramic substrate' billing category?

My second question: Given the likelihood that my insurance will not cover the cost (any of it) for this crown, I also wanted to see if you, as a dentist, had any advice for how to work with my dentist on this issue. Given that my dentist did not provide me with choices of crowns, or clarify that the crown she was using was expensive and not covered by my plan (and, most problematic, not necessary per se), I am not sure how best to handle the situation. I am afraid it may be too late to 'cancel' or 'switch' the order, as I saw her last Thursday (1/17/13) and they said they already sent the impression to the lab (if my assumption is wrong here, please let me know). My insurance told me that if they can't cover it to ask the dental office for a 25% discount. I have already paid and am not sure what my best course of action might be. I liked the manner in which the dentist treated me while the procedure was being done, and do not want to damage the relationship by assuming she did something unethical by not properly informing me of my treatment choice (especially because I expect to go back to her for the permanent crown for now). I intend to speak to the dentist directly, but want to do so in an effective manner. I know that every dentist is an individual, but based on your experience in the field, is this something that is reasonable to pursue and discuss with her (or, worst case scenario, file a complaint), or am I out of luck because I didn't ask questions?

Thank you for your time and advice,
Carol

Answer
Carol -  Zirconium crowns are very strong and their big advantage is that their is no color changes in the crowns near the gum line.  They are crowns that are cosmetically advantageous with the front teeth, because of the lack of color changes in the crown near the gum line.  Porcelain crowns can have a gray appearance at the gum line.  One of their disadvantages is that they can produce erosive changes in the teeth they bite against if they are placed on teeth not in the front of the mouth.  

Your dentist should have offered you options.  This type of crown, is very strong and will not chip, but it can cause its own problems, like I described above.  Your dentist should have definitely given you options financially and the differences in functioning.  You should definitely approach the dentist with a necessity to give you a financial break.  If your insurance covers crowns, they should cover at least a portion of this crown.  

So what I see is a problem with both the doctor and the insurance company.  They should communicate and arrive with a solution so that you are not financially traumatized.  So you should push to have them both arrive at a solution so you are not taken advantage of by both.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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