How to Get Dental Crowns Covered by Insurance in Toronto
Dental Crowns play a crucial role in restoring damaged teeth, improving their function, and enhancing overall oral health. While they are often a necessary treatment, many patients wonder if their dental insurance will cover the cost of crowns.
Insurance coverage for dental crowns varies based on the specific policy, provider, and the reason for the crown. Some plans cover crowns fully or partially if they are deemed medically necessary, while others may limit coverage for cosmetic purposes. Understanding your policy and working with your dental provider can help maximize your benefits.
Before inquiring with your dentist to find out if dental crowns are covered by dental insurance, there are some things that you should know:
- Cost of Dental Crowns
- Insurance Coverage For Dental Crowns
- Factors Influencing Dental Insurance Coverage
- Steps To Maximize Insurance Coverage For Dental Crowns
- List of Dental Insurance Providers in Canada
If you have any further questions about how to get your dental crown covered by insurance at Atlas Dental, please contact us.
Cost of Dental Crown
The cost of a Dental Crown ranges between $1349-1449. The codes relevant to dental crowns in the Ontario Dental Association’s Suggested Fee Guide appear as follows:
Crowns, Porcelain/Ceramic/Polymer Glass
- 27201 – Crown, Porcelain/Ceramic/Polymer Glass: $1099 + Dental Lab Fee ($250-350)
Some crowns are more expensive than others. The three most common dental crown types listed in order from least expensive to most expensive are:
- All Ceramic crowns including Zirconia crowns and Lithium disilicate crowns
- Porcelain fused to metal crowns
- Full metal crowns, including gold crowns
Dental crowns are considered a major restorative service under all dental insurance plans and may or may not be covered by your dental insurance. Be sure to find out from your dental insurance plan provider how much you are eligible for before going ahead with dental treatment. Your dentist can help you submit an predetermination to your dental insurance.
Insurance Coverage For Dental Crowns
Unfortunately, there is no universal answer to whether insurance will cover dental crowns. Coverage depends on your specific plan, policy details, and exclusions. While some plans cover part of the cost, many impose restrictions or do not cover them at all. Coverage is typically offered by private insurers or employee benefit plans.
The Canadian government’s CDCP insurance administered by Sun Life does covers dental crowns if they are deemed medically necessary. However, pre-authorization is required before treatment. Patients should ensure their eligibility through their dentist and obtain approval from the CDCP before proceeding with the procedure.
Factors Influencing Dental Insurance Coverage
Several factors determine whether insurance will cover dental crowns:
- Insurance Policy Terms: Review your policy for exclusions related to cosmetic procedures or specific clauses regarding crowns. Some policies cover up to 50-80% of the cost, while others have annual maximums that may limit reimbursement.
- Pre-Existing Conditions: Some insurance plans impose waiting periods or exclude coverage for pre-existing conditions, such as previously root canal treated teeth with no apparent damage. If you damage a tooth, seek replacement as soon as possible to increase the likelihood of coverage.
- Medical Necessity Clauses: If a crown is required due to decay, fracture, or post-root canal protection, insurance is more likely to cover part of the cost. Cosmetic crowns, on the other hand, may not be covered.
- Waiting Periods: Some insurance plans impose waiting periods before covering major procedures like crowns, which can range from a few months to a year.
- Alternative Benefit Provision: Some policies may only cover the least expensive alternative treatment (e.g., a large filling instead of a crown).
Steps to Maximize Insurance Coverage for Dental Crowns
- Review Your Insurance Policy: Carefully examine coverage limitations, exclusions, and any preauthorization requirements for dental crowns.
- Consult with Your Dentist: Your dentist can provide treatment plans, intraoral photographs, and x-rays that may support your claim for insurance coverage.
- Obtain Preauthorization: Some insurance plans require preauthorization for major procedures like dental crowns. Submitting a request can clarify your coverage before treatment.
- Time Your Treatment – If your insurance has an annual maximum, consider scheduling treatment strategically to maximize benefits.
- Explore Alternative Financing Options: If insurance provides limited coverage, consider payment plans and other financing options.
At Atlas Dental, we aim to ensure that you receive the necessary dental care. We provide a transparent breakdown of costs and payment options so that you can make informed decisions about your treatment. Rest assured, there will be no unexpected charges. If you have additional questions about how to maximize your dental insurance coverage for dental crowns, please contact us.
List of Dental Insurance Providers in Canada
If you are considering dental crowns, you may want to check with the following major dental insurance providers in Canada to see if they offer any coverage for crowns:
- Blue Cross Canada Dental Insurance
- Canada Life Dental Insurance
- Canada Protection Plan Dental Insurance
- Co-operators Dental Insurance
- Desjardins Dental Insurance
- Empire Life Dental Insurance
- Green Shield Canada Dental Insurance
- GroupHEALTH Dental Insurance
- Industrial Alliance Dental Insurance
- Manulife Dental Insurance
- Medavie Blue Cross Dental Insurance
- SSQ Dental Insurance
- Sun Life Dental Insurance
Since coverage varies by plan, it’s always best to contact your provider directly or consult with your dentist to determine eligibility for dental crown benefits. If you have additional questions about how to maximize your dental insurance coverage for dental crowns, please contact us.
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