Dental Crown Denied What Now?

Talk to your employer -- presumably they've purchased this plan on your behalf, and if the insurance company is denying a benefit that is supposed to be legitimately covered per their contract, then they can escalate the matter. After all, its the employer that's being ripped off as well if the benefit is not being paid yet is supposed to be.

Blue Cross, Green Shield or whoever, they are in the business of minimizing what they pay out for covered procedures.

Not every root canal treatment requires a crown. Depends on how much the tooth has been weakened as a result of the decay that necessitated the root canal treatment, and that treatment itself.

And maybe the location of the tooth. I would think that front teeth (incisors and canine) are subjected to less strong biting pressures than pre-molars and molars.

Your wife's plan will have criteria regarding how much structure must have been lost before they will pay for a crown, and I don't think they document this even for dental offices.

While her dentist may feel a crown is in her best interests, a discussion could be had about a post and a filling now with a view to having a crown down the road when it may eventually meet the criteria.

Different dentists may have differing views because there are pros and cons of a crown even without the issue of whether it is covered by insurance.

Sounds like her dentist has exhausted all appeals so your lodging a complaint won't do much unfortunately.