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How much does a tooth crown cost WITH insurance?

i have insurance cigna ppo i think; it also covers dental. my dentist says i need a crown on my bottom right molar how much does it cost on average with a good dental plan, i think mines is good whats considered good i think its like 80% coverage but i'm not sure if it's for crowns too

Public Comments

1. i had 80/20 coverage, it cost me $400. but i am too vein to have them pull the tooth :)
2. Crowns where I live are about $1,000, so with my 80% coverage, it costs me about $200.
3. the charge for a crown in my office is $1,000. IF you have 80% coverage you will have to pay $200 plus your deductable (usually $50 yearly) However I have found that most insurances consider crowns to be "major" work and only cover 50%. You can check with the insurance company directly or have your dentist send in a pretreatment authorization., then you will know exactly what your out of pocket expense will be.
4. The problem with some insurance policies is that even when they say they cover 80% of a given dental procedure, watch out if they use the term UCR which stands for "Usual, Customary, and Reasonable" fee criteria. Basically it means that they will pay 80% of any fee that the insurance company considers to be reasonable; of course, you have to pay the rest. What this means to you is that your dentist may charge you, say, $1000 for a crown. However your insurance company may consider $1000 to be unreasonable and will only pay 80% of the first $800. So instead of paying only $200 for the crown you'll actually end up paying $360!
5. Blurt is right about the reasonable and customary thing. I doubt that you have 80% coverage for crowns. I have been in the dental field for a long time and have never seen an insurance cover more than 60% of a crown. Insurance companies also have all kinds of little rules and limitations, which most patients with very little dental knowledge wouldn't even know to ask their insurance company. Here are some things for you to check into: 1: Does your insurance company downgrade on crowns? Meaning, if your dentist did a higher quality crown, would your insurance company only pay for a cheaper crown. Gold is the best type crown to use for a back tooth, however some insurance companies will not pay for gold and instead will pay for non-precious metal to be used. Ask them if they will pay for all ADA crown codes, or if there are certain ones that they don't pay for. In my office, we do mostly porcelain fused to high nobel metal, which is code D7250, 2: What is the insurance companies UCR (Usual, customary, reasonable) fee for the crown procedure that you are having done? And what percentage do they cover of that? If they tell you that their UCR for your crown is $600, and they cover 50% of UCR, then this means that they will cover $300. If your insurance has in-network dentists, they have to lower their fee to $600, but if you go out-of-network or your insurance doesn't have in-network/out-of-network then the dentist will charge you his normal fee. If his normal fee was $900, then your insurance would still only pay $300, which would leave you a copay of $600, plus any deductible you owe. You should also remember, when a dentist sends in a claim form for a crown, most insurance companies require them to also send an xray of the tooth. They then have a claims specialist review the claim to determine if the procedure was really needed. If they determine that your tooth could have been repaired with an alternative method, they will pay based on that alternative method, which for them is usually a really large filling. Just because the dentist feels your tooth needs a crown, doesn't mean that your insurance company will agree, nor that they will pay for it. They are in the business to keep insurance premiums in their bank account, not pay them out. The more money in their account, and the longer it is in there, the more interest they are gaining. My office is not in-network for any insurance plans, however I have seen what many insurance companies pay on crowns, and some only pay around $275, while others pay over $350. It all depends on that insurance companies UCR.