Medically unnecessary crowns

May 14, 2023
Hi all and nice website! My wife just had a couple of crowns put in. She submitted her claim with United Healthcare.

They denied both as medically unnecessary saying it they were preventative. I'm reading the medical necessity criteria include at least 50% cracking or decay of the tooth.

We are appealing the denials and are now at the mercy of the dentist's narrative.

1. Do dentists consider this medical necessity criteria when offering an expensive service?

2. If the dentist judges that it should be done despite not complying with insurance guidelines, should they not first inform the patient?

My underlying assumption is that dentists know the medical necessity criteria as it took me 30 minutes to research it. Thanks so much!




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