What is "usual & customary" charge for crown? Onlay?

Im just wondering if anyone can tell me what "usual %26amp; customary" charges are for an onlay (which is what I had done today). If not for an onlay, does anyone know what "U%26amp;C" charges are for a crown?


Apparently, onlays are not very common b/c the dental assistant got all excited - "ohhh an onlay - been a while since I've seen one of those done!" (just like the interns on greys anatomy!)....and then, the girl at front desk had no idea how much would be covered by my insurance b/c she didn't know what usual %26amp; customary charges were for it.





Addtional info, in case it makes a difference. It was on a back tooth. I am in Tallahassee, Florida.





Thanks for any HELPFUL answers you can provide!

What is "usual %26amp; customary" charge for crown? Onlay?
about $800.00 usd
Reply:Also thank you for not wasting my time explaining the difference b/t inlays, onlays, %26amp; crowns! ;) Report It

Reply:She also didn't give you an accurate answer either. You didn't give your insurance carrier, the company you work for, or your group ID #, therefore she has no idea if the U%26amp; C for your specific insurance is $800.00. That was obviously a guess. Report It

Reply:At least some of us took the time to try to help you. Shows us dental professionals not to waste our time helping others I guess. Report It

Reply:Your very welcome dear! =) Report It

Reply:The term "usual and customary" was invented by insurance companies to determine their level of benefit. It really doesn't mean much in real-world dentistry.





Onlays can be done in all porcelain or precious metal, such as gold. Depending on the lab, the fee could run as high as $1000 for a top quality all porcelain onlay. Crowns and onlays might be about the same price because of prep time involved and lab fees. A crown would be a full-coverage option, an onlay would only be a partial coverage. Either procedure can be pre-authorized through your insurance so you will have a better idea what would be covered.





There is no excuse for the front desk person not to know their fees. When in doubt, the staff can always say, "let me check with your insurance company and give you an estimate later today."





Honestly, unless you are really comfortable with this dentist, you might ask for a second opinion.





Edited to add: thanks for additional info.


The best person to check the U %26amp; C might be you. Call your insurance company and ask them. The pre-authorization is still the best way to go, but it sounds like the procedure is already started.


When you call your insurance company, ask for their U %26amp; C on code D2643 (porcelain/ceramic) or D2543 (metal/gold).
Reply:$935 sounds like it is right in the ballpark. But the U%26amp;C your insurance comes up with can be anywhere they want it to be. It is just a number they make up to define what they will pay.
Reply:I don't know who gave Emmalue a thumbs down, because she is absolutely accurate.


Usual and customary is a fee set by an insurance company. Since every insurance company is different, and usually have many different individual policies, the best place to get this information is your insurance company. Be aware though, that many insurance companies will not give out this information. I have called numerous insurance companies to find out what their usual and customary charge is on a procedure, only to be told they don't give those out over the phone. It makes no sense to me, but you cant force them most of the time.





Usual and customary charges are set by the insurance companies, bases on what they feel a procedure should cost. They do not take into consideration what materials the dentist uses, what lab they use, the dentists qualifications, or any of that. Many of the insurance companies out there, do not consider a inlay/onlay a covered benefit. WHY?? Who knows! Why they would think it benefits the patient to have all the enamel shaved off their tooth and a full crown placed, is beyond me. But thats an insurance company for you. They may downgrade your onlay to a crown, meaning they will pay 50% of the usual and customary fee of a full coverage crown. Some insurance companies don't cover porcelain on a molar, so they may downgrade it to the "Cheapest acceptable restoration" as they put it, which would usually mean a porcelain fused to non-precious metal crown. Lets hope yours doesn't do that.





Many dentists are into the old school methods and don't tipically diagnos onlays. I think it is a real disservice to the patient to do a full coverage crown if they have tons of great, healthy enamel. Why more dentists don't just remove the bad part and fit a porcelain onlay on the tooth is beyond me. Onlays are common, but it depends on the office you go to. In my office they are quite common actually.





Sorry I couldn't actually give you the usual and customary fee, but if you get the ADA code, you can probably call your insurance company and ask if they will tell you. Also be sure to ask if they allow these to be done on molars, and if they downgrade them to a full crown.