Will My Insurance Cover a Metal-Free Dentist?

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I have crowns across my front teeth and over time a gray line has formed at the gumline. At first, I was afraid something was seriously wrong, but I looked it up and read that it’s actually the metal part of the crown showing through. I want to see a metal-free dentist to have it done. Since dentists don’t seem to publish their rates, and there’s nothing listed in my insurance book about it, is it covered, and is there a price difference in the two?


Erika in Texas

Dear Erika,

It sounds like you’re right about the gray line. That commonly happens as the gums recede over time. Yes, the only way to fix it is to have new crowns made. A metal-free dentist can help with that, and you can be sure your next set of crowns won’t wind up with the same aesthetic problems. You may be able to find a holistic, cosmetic, or general practice that practices metal-free dentistry.

Insurance works based off of procedure codes, so it generally doesn’t matter which kind of office you visit. Most, but not all, insurance companies, will pay 50% of a crown. The catch is, they will only pay for 50% of the least-expensive type of crown, which is usually the kind with a metallic underlay. Moreover, there are numerous alternatives for materials, different skill-levels of dentists, and costs vary depending on your region. When they pay what they would have paid for a less expensive procedure, they call this “downgrading.” In the end, you might find an office where your copay is no different, or you might find out that insurance sticks you with a bill of hundreds of dollars.

In short, if you have coverage for a traditional crown, you probably have similar coverage for one without the metallic base, called a porcelain crown. An all-porcelain crown does not have the metal framework so you don’t have to worry about the ugly line reoccurring. If costs are of major concern for you, the office can submit a pre-authorization. This is also called a predetermination of benefits, which will lay out exactly what the insurance company intends to pay.

This post is sponsored by Lexington cosmetic dentist Hamburg Expressions.