CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. HTn0?N$vt.taQ"]QI~}kGvc:PXJ ,DDIuEE}%uDp'QMXzm:h?cZH;%*E[*& RNa: 0000025338 00000 n Enter the street name or intersection instead of address numbers (24th and Broadway instead of 2432 Broadway). The primary payor pays claims as it normally does. 0000048067 00000 n \Jc sVB;xN"#~D=1GE SJ4{[HM`|x>~y\YgO_YQ la70'1!!7FY%^P\iRk*#L n~^IJ54g+Rq k (C8y}H7=s2TiUfS^|d yfGBak44\@j My Dental PPO - MetLife If you need interpretation services and are enrolled in the Preferred Dentist Program (Dental Vision hardware fee schedule is available through the ESD contract. Verify the spelling of the street name or city. Employees can choose between an extensive network of dentists and oral care specialists so they find a provider best suited for their needs. As the leading provider of dental benefits and largest commercial carrier, MetLife is committed to helping your employees maximize their benefits. I want information specifically for 0000044035 00000 n You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide. Links to various non-Aetna sites are provided for your convenience only. HW$WtM7GmFx4;c}""ztl3*_}"_^_Vkj*[iBK+i?n~/_-la6l{^}m>lq><9n?[{*w^G{e7+Q1V\tm8Vxp7%^t9u(28~Z6v{uf{T% 59Wv_[\}#=a.E1hqYM"8dT1!`9~]hGuDKGgyQ\knr[{tEr:Ad^KbP\9RuCn,sSvjkP(G#OJt3ooQc 1(*@v ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. You or your dentist may also call Member Services. WebLike most group benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions of benefits, limitations ), If you choose a new PCD on the sixteenth day of the month or later, the change will go into effect two months afterward. Provider Quick Reference Guide Find your dentist now in Aetnas large nationwide network. 0000001199 00000 n The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. endstream endobj 4805 0 obj <>stream Every enrolled family member may select their own primary care dentist. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. If so, the primary care doctor will arrange it. To change your PCD, log in to your member website. HMo0?v:JzXc/Y~ 4$8#27t9hkG~NMf]n+tAk Wh._AkJ~Mm1.O]f.ixk% (ABT iE%Jz,3X6#N]W_Q.v(>2(0CH*vy!f( Before you provide certain services, you will need to submit authorization request forms. HtTYo@~0IOHC and Section 504 of the Rehabilitation Act of 1973. Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met. When you go to or call the dentist, tell the office staff that you have Aetna Dental DMO. All Rights Reserved. Or contact Member Services for coverage details. See Access to Baby and Child Dentistry (ABCD). 0000037307 00000 n Please contact Member Services. This material is for information only. If you do not intend to leave our site, close this message. Dental WebMetLifes Table of Maximum Allowable Charges or Fee Schedule applies to dental procedures performed on eligible members participating in MetLifes Preferred Dentist 1-855-MET-EYE-1. !f"UF =,T).ts It describes the services you have coverage for under your plan. To find out, just call Member Services. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. hbba`b``30 Ga No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 0000136750 00000 n You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. If so, we will confirm which plan has primary responsibility for claim payment. 0000044706 00000 n In case of a conflict between your plan documents and this information, the plan documents will govern. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. endstream endobj 4796 0 obj <>stream If you had coverage under a previous insurance carrier, youll have coverage for certain services by that plan even after your Aetna coverage begins. Aetna Dental The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT), copyright 2015 by the American Medical Association (AMA). This page contains billing guides, fee schedules, and additional billing materials to help you submit: Coronavirus (COVID-19) information. Virginia members: In Virginia, DMO is called DNO (Dental Network Only). Aetna Inc. and itsaffiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Altamonte Springs dentists Boca Raton dentists Clearwater dentists Coral Gables dentists Coral Springs dentists Daytona Beach dentists Delray Beach dentists Englewood dentists Fort Lauderdale dentists Gainesville dentists Grove City dentists HQK0+.y+B")RaO m!n[d]{1|9s}Z2t6BIe)U$}C`u! Have your dentist send a pretreatment estimate (predetermination) to us. To find out additional fee information on common procedures in your area, the process is simple Hn0} The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. Contact Us. Oral surgery You pay 20% of covered services for basic surgery; 50% of covered major surgery. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. endstream endobj 4797 0 obj <>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 4798 0 obj <>stream Dental endstream endobj startxref CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. WebNot all employer groups associated with these Payors will utilize the Connection Dental Network. It is only a partial, general description of plan or program benefits and does not constitute a contract. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. Each main plan type has more than one subtype. They will be able to verify your coverage. Depending on your plan, you may pay for dental care in one of two ways: There are no deductibles or annual dollar maximums. Direct Referral Dental Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. 0000142900 00000 n \-.m\EqYt0.\fj JR 4828 0 obj <>stream access to covered services, including insureds with disabilities as Find individual dental insurance plans near you with budget-friendly coverage options and get a quote. Exams are covered every six months (if using a participating dentist, there is a $15 co-payment). Yes. WebOral surgery. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. %PDF-1.7 % Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Please log in to your secure account to get what you need. 797 0 obj <>/Filter/FlateDecode/ID[<37A34B695481DA4B83FCA71461750ABE><99A26598FF436C418BD6EB0A4885ABA5>]/Index[779 47]/Info 778 0 R/Length 98/Prev 235657/Root 780 0 R/Size 826/Type/XRef/W[1 3 1]>>stream (Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide. We need to authorize the use of a different provider before treatment. Yes. Applicable FARS/DFARS apply. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. For telehealth policies and FAQs, see Telehealth on this page. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 0 0000032811 00000 n Register and log in to your member website. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. If you need more information, contact Member Services. Provider billing guides and fee schedules - Washington Hn@})R$R(8I1$o0Z?IT @m$,RRW$_yV? Illinois DMO is not an HMO. WebMetLife has the largest range of dental insurance plans and providers among dental insurance organizations. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. See Physician-related/professional services for information regarding vision exams and related services. Who can enroll in the plan? It sets what they can charge for covered services. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). This search will use the five-tier subtype. other economic conditions. Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.
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