WebProcedure Fees. HS]O0}_qd_TILXv]@O.K{=p> X1R)MD*u 7p\y D2a\&bh1hq{.uNj`)9T@*pU&T!Bz $2ToWIGtfN.[4y7n1MDP0j=g*E^ X2SYJsOJ=I!J]D]KRihmOS-f&nR#wa{:f$f? Or contact Member Services for coverage details. Some problems may need more than one service to fix. t|%y,$Z1/7`v||f})"h[sE\o~_z~$q-`?X \h-:tm){1U:;%j%D^TN"pX'nw]Fs3)bNiA@g4,pLk,k{s6?}J}A &\R:lf~>W1C",h+QZ{K'.52 zYtVIp`0 x{B&$M"yhZICt`0> :1r 2!iMFnAo)1%i"74/+v[0N)mgaJY[X _1d7$3H\3. (Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide. Check your Aetna Summary of Benefits. Links to various non-Aetna sites are provided for your convenience only. License to use 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. This means if you have two plans that cover two cleanings per year, you dont have four cleanings per year. 0000072473 00000 n Unlisted, unspecified and nonspecific codes should be avoided. 0000039476 00000 n Use the billing guides and fee schedules to find rate information and the ProviderOne Billing and Resource Guide to walk through the claims process. 0000016913 00000 n Yes, but some plans may limit the benefit to certain teeth. CPT is a registered trademark of the American Medical Association. Have your dentist send a pretreatment estimate (predetermination) to us. Exams are covered every six months (if using a participating dentist, there is a $15 co-payment). 0000043626 00000 n 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. 1s a5S q b6L4 . \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 Signing up is simple and free. The AMA is a third party beneficiary to this Agreement. WebWorldwide dental coverage and plans with no deductible New Hires have 60 days to choose benefits. For language services, please call the number on your member ID card and request an operator. Call Customer Service at 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 so, most services will be considered separately. 825 0 obj <>stream For fee schedule and rate questionsEmail:ProfessionalRates@hca.wa.gov, For all other provider questionsMedical Assistance Customer Service Center (MACSC)Online: secure formPhone: 1-800-562-3022, Website feedback: Tell us how were doing, Copyright 2023 Washington Health Care Authority, I help others apply for & access Apple Health, Apple Health for Workers with Disabilities (HWD), Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services & supports (LTSS) manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. WebMetLifes Table of Maximum Allowable Charges or Fee Schedule applies to dental procedures performed on eligible members participating in MetLifes Preferred Dentist 0000038707 00000 n Hn0R`~(dQQl\0H5oKtFA?v>4.zL >.K;J+p0eLK!YWU-`}\~nxqC79*G: >$LAFMEECJ.&rwBx77C(gOI CHAwl"4Q !b p^y2gp#M 0000038958 00000 n Find a dentist near The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. )SI{ 0BO|cEs}Oq""TV}c`u-hSwi8J", %%EOF Enter the street name or intersection instead of address numbers (24th and Broadway instead of 2432 Broadway). WebAmount of every $100 in premiums used to pay for claims and administration for the year ending Dec. 31, 2017 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. WebCritical access information for providers MHCP Fee Schedule (MHCP Fee Schedule (dental codes begin on page 55 of the PDF) Fraud, Waste, and Abuse: Combating Medicare Parts C and D Fraud, Waste and Abuse Training Web Based Training Course 2022 Fraud, Waste and Abuse Attestation Fraud, Waste and Abuse Training Log Additional Resources Illinois DMO is not an HMO. When you go to or call the dentist, tell the office staff that you have Aetna Dental DMO. Applicable FARS/DFARS apply. Your plan may have a coordination of benefits provision. See Access to Baby and Child Dentistry (ABCD). Therefore, it is crucial to verify benefits and eligibility with the Payor. 0qPWp:dW5 ;6V]BpJ#@DE"?Fo=+57]>>=@^{"p5yM~'A}t`)6ts(T^ `p]~@5zPn/VO=RB;#Gkj@!bg~7s}f This page contains billing guides, fee schedules, and additional billing materials to help you submit: Coronavirus (COVID-19) information. WebYou can obtain an updated procedure charge schedule for your area via fax by dialing 1-800-942-0854 and using the MetLife Dental Automated Information Service. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. ? See Physician-related/professional services.). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. I was billed more than the standard $150 co-payment for a crown. Use the ProviderOne portal to see if a client is eligible for the service and the billing guides and fee schedules to determine if a PA is required. However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Copyright 2015 by the American Society of Addiction Medicine. 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 The PCD has primary responsibility for managing your dental care. Download the free app today. WebFind a Dentist. Disclaimer of Warranties and Liabilities. 4828 0 obj <>stream WebDenteMax is one of the largest leasable dental PPO networks in the United States. Aetna Inc. and itsitsaffiliated 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. hb```b`b`e`eb@ !f(GBC S1(500;1T5~`;4a> O@s'IW5yLrWqcrED]:b53l 2& CEg 120bpg7E'21Jn- (o-ee` y.4 H30-f1p' `[ 0000044288 00000 n CPT only copyright 2015 American Medical Association. 2023 MetLife Services and Solutions, LLC 0000021213 00000 n If this occurs, please refer to the most recent guide. Most PCDs treat children and can refer members to a pediatric dentist, if necessary. WebYikes, something went terribly wrong!!! WebYikes, something went terribly wrong!!! Your and Your They do so as if there is no secondary payor. hbbd```b`` 779 0 obj <> endobj 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Find individual dental insurance plans near you with budget-friendly coverage options and get a quote. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Hn0} It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Click home to navigate to home.. Click reset to reset the application.reset to reset the application. The member's benefit plan determines coverage. If you are a participating provider with one or more dental benefit plans, you may want to negotiate with those 0000035839 00000 n HQK0+.y+B")RaO m!n[d]{1|9s}Z2t6BIe)U$}C`u! Members cant choose a pediatric dentist as their PCD. Notice: Past billing guides may have broken links. endstream endobj 4805 0 obj <>stream Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. 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. Register and log in to your member website. Oral surgery You pay 20% of covered services for basic surgery; 50% of covered major surgery. The secondary plan acts like a supplement to the primary plan. 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. WebMetLife has the largest range of dental insurance plans and providers among dental insurance organizations. Visit our Document submission cover sheets page to find the barcode cover sheets required with additional documentation. {YO2GMP!BJMP(!/(q@>6 0 1 If we have primary responsibility, we will pay as the primary payor. 0000016734 00000 n endstream endobj 4797 0 obj <>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 4798 0 obj <>stream 0000044035 00000 n Aetna Dental members dont need a member ID card to get dental care. The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. *Illinois members: State laws vary with regard to out-of-network benefits. Depending on your plan, you may pay for dental care in one of two ways: There are no deductibles or annual dollar maximums. Click home to navigate to home.. Click reset to reset the application.reset to reset the application. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Under these circumstances, dental offices may see the need to adjust their fee schedules. 0000029561 00000 n Top 3 reasons to choose Aetna Dental Your choice of any licensed dentist, in or out of network, worldwide, including virtual providers 50% of costs until plan has paid $1,750, then any HMo0?v:JzXc/Y~ 4$8#27t9hkG~NMf]n+tAk Wh._AkJ~Mm1.O]f.ixk% (ABT iE%Jz,3X6#N]W_Q.v(>2(0CH*vy!f( CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. In case of a conflict between your plan documents and this information, the plan documents will govern. You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. 0000050787 00000 n trailer All Rights Reserved. They arent a PCD. Aetna Inc. and itsaffiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. 0000071744 00000 n If you need more information, contact Member Services. You can find a network dentist with our online directory. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 206 0 obj <>stream The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. WebSchedule of Benefits . We need to authorize the use of a different provider before treatment. os yI"f]Ez| y n1|8(AV0jxU&hz=Hw 9\VMwwh!B lsJB&)C|N!!Xr&K{k9i[MU[oKSk&X2EUxkvlM~W They will be able to verify your coverage. 0000037929 00000 n hbbd```b``v> >d(XM|&c0L*e$li6"A@Lg` hT For other specialists, a referral may be necessary. WebPlease note all requested contact information is for the provider * Due to contractual requirements, MetLife is prevented from soliciting certain providers. For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide. Virginia members: In Virginia, DMO is called DNO (Dental Network Only). Actual CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. 163 44 The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. endstream endobj 780 0 obj <>/Metadata 30 0 R/Pages 777 0 R/StructTreeRoot 55 0 R/Type/Catalog/ViewerPreferences 798 0 R>> endobj 781 0 obj <>/MediaBox[0 0 612 792]/Parent 777 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 782 0 obj <>stream
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