Crowns (Dental): FSA Eligibility

Crowns for cosmetic purpose only are not eligible.

What are dental crowns?

A dental crown is a prosthetic device that is often referred to as a "tooth cap," which is used as a means of replicating the appearance of a damaged tooth to restore its size and shape, as well as the overall strength of the original tooth. This form of dental restoration can be utilized around a natural tooth or a dental implant, and is made by making a dental impression of a prepared tooth to fabricate the crown outside of the mouth, at which point it will be constructed and implanted into the patient's mouth. Crowns can be made with myriad materials, such as gold, porcelain, ceramics, acrylics and metal alloys (American Dental Association).

When are dental crowns used?

Crowns are often referred to as cosmetic procedures to restore the appearance of a damaged tooth, but they are often needed in a variety of situations that can be deemed medically necessary, including via WebMD:

• Crowns are often used as the foundation for dental bridges, which are commonly used to replace one or more teeth and span the space where the teeth are missing.
• To replace a large filling if there is not enough tooth present to maintain the structural integrity of the tooth
• To replace a damaged tooth, to strengthen the integrity of a weaker tooth or to cover a dental implant to prevent it from breakage.
• In some cases, dentists may use crowns to cover a tooth that has recently had a root canal treatment to reduce the risk of oral infections.

How do I obtain a Letter of Medical Necessity (LMN) for dental crowns?

A Letter of Medical Necessity (LMN) from a doctor for dental crowns may or may not be necessary for reimbursement with most benefits providers to ensure that it is necessary for the treatment of a medical condition. This letter must outline how an account holder's medical condition necessitates dental crowns, how the treatment will be used to alleviate the issue and how long the treatment will last. This is submitted to the account holder's benefits administrator who then determines whether it will be reimbursed through their consumer-directed healthcare account.