See Physician-related/professional services for information regarding vision exams and related 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. 0000142900 00000 n The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 0000038707 00000 n Treating providers are solely responsible for dental advice and treatment of members. Disclaimer of Warranties and Liabilities. To find out, just call Member Services. $10 to $50 to extract a tooth. You can find a network dentist with our online directory. 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. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. 4792 0 obj <> endobj This applies to services for: For more details, review your plan documents. Every enrolled family member may select their own primary care dentist. Since Clinical Policy Bulletins (CPBs) 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. Direct Referral Dental Plan* MET185A. endstream endobj 4802 0 obj <>stream Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Dental Please see your plan documents. There are several types of coordination of benefits provisions. 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. m-4f'f{">H746Z5apg`u0? 0000001836 00000 n Check your Aetna Summary of Benefits. You can also view and share your digital ID card from the Aetna Health app. G Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. w)A7ilBnx_^bu>3E;LU,Nhs%v1&OvC:-R/mTpm:3]q%ih*N WebJust select a participating dentist at enrollmentthen refer to your Schedule of Benefits to see what's covered and your costs. hbbd```b`` Select one of the SafeGuard DHMO Plans or one of the MetLife Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. interpreter services at no cost. G!Qj)hLN';;i2Gt#&'' 0 By contacting the Payor, a provider can identify which network fee schedule is being utilized for claim reimbursement and verify participation status with the plan. They arent a PCD. 0000032811 00000 n 206 0 obj <>stream Sign up at BeneFeds.com or call 1-877-888-3337. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. Therefore, it is crucial to verify benefits and eligibility with the Payor. 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. Any languages spoken in offices indicated in this search are self-reported. 0000035839 00000 n ;^{s4)|I6gPvJ=x WebDelta Dental has the largest network of dentists nationwide. Treating providers are solely responsible for medical advice and treatment of members. \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 WebMetLife has the largest range of dental insurance plans and providers among dental insurance organizations. Yes, but some plans may limit the benefit to certain teeth. Do you need a barcode cover sheet? Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. Compare dental plans | Washington State Health Care Authority Select "Search" to go to the Find a Dentist tool, choose your network and enter your ZIP code for a list of participating dentists. The MetLife dental network includes thousands of providers, so finding the right dentist is easy. Our plans give you the flexibility to visit providers in or out-of-network. 3 Most cleanings and exams are covered 100%. My Dental PPO - MetLife Hn@})R$R(8I1$o0Z?IT @m$,RRW$_yV? How do I notify SEBB that my loved one has passed away? Do you need a PA form? BG[uA;{JFj_.zjqu)Q Find your dentist now in Aetnas large nationwide network. How does the plan save me money? Just enter your mobile number and well text you a link to download the Aetna Health app from the App Store or on Google Play. Each DMO member must select a PCD. 1-855-MET-EYE-1. In Illinois, DMO plans provide limited out-of-network benefits. The Apple Health PDL can be found on the agency's Apple Health PDL page. How are claims Yes. 0000037307 00000 n For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide. Visit the secure website, available through www.aetna.com, for more information. %%EOF For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page. Unless required by state law, a pediatric dentist is considered a specialist. These rules determine Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". 0000136999 00000 n You can also contact Member Services to determine if they are eligible under your DMO plan. Others have four tiers, three tiers or two tiers. Register and log in to your member website. 0000021213 00000 n You must contact us. WebThe sequestration reduction amount for each affected claim will be identified on the explanation of remittance healthcare providers receive from Humana. Periodontal maintenance is for patients whove previously had periodontal treatment. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. 20% PPO and out-of-state; 30% non-PPO. hbbd```b``v> >d(XM|&c0L*e$li6"A@Lg` hT CPT only Copyright 2022 American Medical Association. MetLife Vision contracted providers allow full and equal The primary payor pays claims as it normally does. WebProcedure Fees. How do I notify PEBB that my loved one has passed away? Verify the spelling of the provider's last name or office name. xref Metlife - Member Dental Plan Benefits - Member Benefits If you do not intend to leave our site, close this message. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Your and Your CPT is a registered trademark of the American Medical Association. n[F$6_KZi4k 0000113149 00000 n However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Find individual dental insurance plans near you with budget-friendly coverage options and get a quote. 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. 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. endstream endobj startxref 6p6@-_2PA p-S:{c:=q|%~nH09ML{Z 'zS'-'&w.&Xu-.@N In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. WebWorldwide dental coverage and plans with no deductible New Hires have 60 days to choose benefits. endstream endobj 4801 0 obj <>stream 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( January 1, 2023 to present Dental program fee schedule (updated January 26, 2023) Information is believed to be accurate as of the production date; however, it is subject to change. Fee Lookup Refer to the current Physician-related/professional services for information regarding blood, blood products, and related services. WebJuly 1, 2022 to present Mobile anesthesia for dental services billing guide; Fee schedules. startxref endstream endobj 4799 0 obj <>stream For Apple Health clients and clients of the Developmental Disabilities Administration. endstream endobj 164 0 obj <>/Metadata 15 0 R/Pages 14 0 R/StructTreeRoot 17 0 R/Type/Catalog/ViewerPreferences<>>> endobj 165 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 -306.0 -396.0]>>/PageUIDList<0 152>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 166 0 obj [/Separation/PANTONE#20376#20C/DeviceCMYK<>] endobj 167 0 obj [/Separation/PANTONE#20347#20C/DeviceCMYK<>] endobj 168 0 obj [/Separation/PANTONE#202995#20C/DeviceCMYK<>] endobj 169 0 obj <> endobj 170 0 obj <>stream WebCan I get an estimate of my out-of-pocket expenses? 4+t?1zxn nmZn5&xUAX5N(;a,r}=YUUA?z r[ $ WebBoth of our dental plans include: Comprehensive dental services, from preventive care to crowns, bridges and dentures No in-network deductibles and no waiting periods, including orthodontia for children and adults Worldwide coverage with a large nationwide network. You can reach them at the number on your member ID card. You can reach them using the number on your ID card. *v:G)JeU%IcRr)\%Ts6q^HpCw-yAuYxU'`ho(7;v};}%-`Fuak`Htf,i1+S|@n-2yC%\rk&(NV;*_(bH *-y;tKMJE-V4"%!GUTEj)/3R$F`}C f0]o~lb>9=Grn5+;X@:D?CwX}/fb'e[=A3[ ~m;j\ZOE%H8RsZg ~mH.l%:~EYwO-$Hcm6dqaW[dc( z Choose a category below to see questions and answers about Dental Maintenance Organization (DMO) coverage. HTn0?N$vt.taQ"]QI~}kGvc:PXJ ,DDIuEE}%uDp'QMXzm:h?cZH;%*E[*& 0000001499 00000 n required under the federal Americans with Disabilities Act of 1990 CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. Dental You are now being directed to CVS Caremark site. For language services, please call the number on your member ID card and request an operator. 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. Actual Your benefits plan determines coverage. This page contains billing guides, fee schedules, and additional billing materials to help you submit: Coronavirus (COVID-19) information.
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