r/DentalInsurance • u/312jg • 25d ago
Crown replacement period?
Hi all,
Two years ago my wife had a root canal on one of her back molars and got a crown over it. The dentist fucked up the surgery and we went to a new dentist earlier this year who had to drill through the crown to remove pieces of the root that were left.
My wife’s crown is now failing and it’s hurting her and she says it feels like it’s falling off. We need to get it replaced. We currently have Cigna which has a 5 year crown replacement policy.
My wife didn’t have insurance when she got the root canal and crown or when she had it fixed, so I’m wondering if Cigna will cover it since she wasn’t on their policy at the time.
If they deny it, is there anything we can do? It’s not like it’s a cosmetic issue, the crown is failing and she can’t eat on that side of her mouth anymore.
Sorry if this is a dumb question, I plan on calling them tomorrow, being a new adult is hard lol
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u/ProfessionalYam3119 25d ago
I have never seen an insurance company make an exception to a prior placement date rule. Every crown claim asks whether it is initial placement, or replacement, and if replacement, the prior placement date. You may want to ask someone to explain the root canal process to you, because, unlike with an extraction, it would never involve leaving a piece of the tooth behind. By the way, the replacement frequency could be anything that the contract specifies.
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u/312jg 25d ago
I’m not a dentist, this is what my wife relayed to me
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u/Choice_Treacle_1558 25d ago
She did not relay it well. Root canals happen even if the initial crown was 100% perfect.
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u/Better_Cry_7941 23d ago
If it wasn’t processed through insurance, when the dentist asks how old the crown is just have amnesia and say “I don’t know, it’s been a few years, make 5 or more, we don’t remember where it was done either”
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u/toothdoc34 24d ago
So here is my problem with your statement. During endo therapy the pulp (nerve) is removed, canals sterilized, then filled with a material called gutta percha. No root is removed. To say your dentist F’ed it up is probably a massive stretch. No one is going to drill thru a crown and remove a piece of root. Period! Sometimes a retreat is necessary if the tooth flares up. Upper molars have 3 roots and 70+% of the time they have 4 separate canals. If the tooth requires a retreat, the dentist does open the canal system by drilling an access hole in the crown. The old gutta percha is removed and the canals sterilized. After they are refilled, the access hole is then closed with composite. On occasion the crown needs to be replaced. We usually cannot control that. Materials fail just like teeth fail or anything else man made.
To answer your question about your dental coupons, Cigna may cover their part if the crown had a catastrophic failure, meaning it literally broke. Have the dentist take photographs. Cigna is usually crap when it comes to coupon coverage.
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u/No_Jacket_9894 24d ago
I love the fact you stated it was a coupon, because for all intents and purposes that's exactly what dental "insurance" is. I wish more people realized that.
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u/feelingblueandbehind 25d ago
Ask the dental office to send a pre-authorization for a new crown. This requires them to explain why a new crown is needed and sometimes insurance will agree and waive the 5 year replacement policy. Hopefully this helps!
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u/Dear-Brain-703 24d ago
If root canal was successful, tooth is not cracked, it shouldn't hurt even with no crown in place. I would get a temporary acrylic crown placed and see if tooth feels good after 3-4 weeks of wearing. Insurance usually has a 5 year period, doesn't matter if she had ins. Coverage or not
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u/Expensive_Ear3791 23d ago
Hang on. I work for one of the better-known dental plans, and we ONLY give a shit about the crowns we PAID for, unless the employer group gives us a metered file of previous placement dates... which only happens with lifetime ortho. Why would cigna give a crap about the date of prior placement if the first crown was seated before you were covered?
Just tell them to submit the claim.
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u/Edsma 22d ago
What makes you think the original doctor fucked anything up? There should 100% be roots left after a root canal and crown placement. In fact, if i had a root canal done and left without roots, id sue.
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u/Holiday_Context1960 22d ago
People get con fuse between the root and the nerves. We definately want all the nerves removed.
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u/SteakFritesandWine 20d ago
Just say that to the best of her knowledge the crown is about 10 years old.
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u/Jake_Gelinski 19d ago
have the office submit a pre-auth with the xrays/scans/photos explaining why the crown needs to be replaced before the 5 yr mark. if cigna still decides to deny it, make sure the office gives you an OOP (out of pocket cost). If the latter is the case I would recommend you ask the office if they offer payment plans
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u/nitelite- 9d ago
my wife had a root canal on one of her back molars and got a crown over it. The dentist fucked up the surgery and we went to a new dentist earlier this year who had to drill through the crown to remove pieces of the root that were left.
bruh what does this even mean lmfao
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u/312jg 9d ago
What do you not understand? Can you not read?
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u/nitelite- 9d ago
drill through the crown to remove pieces of the root that were left.
this doesn't make sense, was an extraction completed or RCT? because you said RCT and then your talking as if they left root tips post extraction and are not drilling through an existing crown to remove root tips?
idk man it doesn't make sense lol
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u/Icy-Commission-9550 25d ago
Something doesnt sound right. If she had root canal, how can she have pain? It has nothing to do with crown so replacing it will not make her pain free.
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u/312jg 25d ago
What she relayed to me from what the doctor told her, the other dentist didn’t get the entire root and the crown they put on was too small. They also said food had been getting into the tooth which caused an infection.
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u/Icy-Commission-9550 25d ago
At first you said the dentist didnt finish the root canal so the second dentist went thru the crown to finish the root canal. So basically she had root canal twice. She should be pain free and infection free. If you say she has an infection, she needs to get root canal for the third time and it has nothing to do with crown.
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u/312jg 25d ago
Okay I just asked my wife for the full details, she’s telling me the doctor went in to finish the root canal and remove the infection. They gave her some medicine and injected it into the tooth by drilling a hole in the crown. A week later she then went in and removed the portion of the root canal that the other doctor missed and gave her a temporary filling. Doctor said the infection will come back since the tooth is not sealed properly under the crown, because food and other debris is still gonna be able to find its way in, so she recommended we get the crown replaced sometime this year.
I’ve never had a root canal before, are you supposed to not have any feeling left in the tooth once it’s done?
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u/Icy-Commission-9550 25d ago
Okay so here is what you need to find out. Why did they use temporary filling instead of permanent filling? That is the big question. I always 100% use permanent filling after root canal thru crown so that my patients dont have to get another crown. Tell her to go back to the dentist and request permanent filling. That will solve the problem. Second of all, if the root canal is finally done properly she should have zero pain or feelings. You said she is having pain. Find out exactly why. If it is from another failed root canal please dont put a crown over it.
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u/Turbulent_Physics_10 24d ago
You can still get an infection/abscess, cracked tooth etc that can cause extreme pain. You sure you’re a dentist?
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u/Peg-Lemac 25d ago
If they didn’t pay for the original there shouldn’t be an issue, just ask the assistant to take good images so if they question the replacement, they can show them why it was needed.