Or you can contact Member Services. When you go to or call the dentist, tell the office staff that you have Aetna Dental DMO. Some services have this type of restriction. 0000016734 00000 n Exams are covered every six months (if using a participating dentist, there is a $15 co-payment). How are claims Benefits provided by SafeGuard Health Plans, Inc., a MetLife company. You can find a network dentist with our online directory. Register and log in to your member website. You can reach them using the number on your ID card. Under these circumstances, dental offices may see the need to adjust their fee schedules. 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. general dentist or specialist who meets MetLifes strict credentialing The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. The ADA anticipates that the costs of providing care will substantially increase for many dental procedures. Find a dentist near Please see your plan documents. 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 4812 0 obj <>/Filter/FlateDecode/ID[]/Index[4792 37]/Info 4791 0 R/Length 101/Prev 537656/Root 4793 0 R/Size 4829/Type/XRef/W[1 3 1]>>stream 0000037168 00000 n 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. The ABA Medical Necessity Guidedoes not constitute medical advice. 'u s1 ^ n[F$6_KZi4k 0000104077 00000 n You or your dentist may also call Member Services. <<5AE96FDB43CC14498BFAFB7B8207E05A>]/Prev 310465/XRefStm 1499>> Links to various non-Aetna sites are provided for your convenience only. 0000043626 00000 n 20% PPO and out-of-state; 30% non-PPO. Visit our Forms and publications page to download authorization forms. 0000036990 00000 n In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. You can see if your plan has a work-in-progress exclusion. 50% of costs until plan has paid $1,750, then any This means if you have two plans that cover two cleanings per year, you dont have four cleanings per year. WebCan I get an estimate of my out-of-pocket expenses? Altamonte Springs dentists Boca Raton dentists Clearwater dentists Coral Gables dentists Coral Springs dentists Daytona Beach dentists Delray Beach dentists Englewood dentists Fort Lauderdale dentists Gainesville dentists Grove City dentists Orthodontia. Our procedure fee tool provides participants of dental plans insured or administered by MetLife guidance in understanding your dental service providers fees. The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. 0000136750 00000 n 0qPWp:dW5 ;6V]BpJ#@DE"?Fo=+57]>>=@^{"p5yM~'A}t`)6ts(T^ `p]~@5zPn/VO=RB;#Gkj@!bg~7s}f No fee schedules, basic unit, relative values or related listings are included in CPT. Visit the secure website, available through www.aetna.com, for more information. O . WebFind a Dentist. 0000017206 00000 n 0000000016 00000 n Unless required by state law, a pediatric dentist is considered a specialist. They do so as if there is no secondary payor. Before you provide certain services, you will need to submit authorization request forms. FAQ | MetLife MetLife Vision contracted providers allow full and equal endstream endobj 205 0 obj <>/Filter/FlateDecode/Index[17 146]/Length 27/Size 163/Type/XRef/W[1 1 1]>>stream HW$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 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? If so, most services will be considered separately. 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. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 0000086757 00000 n m-4f'f{">H746Z5apg`u0? Treating providers are solely responsible for medical advice and treatment of members. 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. Disclaimer of Warranties and Liabilities. TmEg=boq1c8-,4%n (x@q U?eVzfK@X^=|?UOeq}:C |zYlK$"91q''o%$D?('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 endstream endobj 4803 0 obj <>stream 0000050787 00000 n Log in to find a dentist who accepts your coverage. &~gHE}7m3_I<3I$$MYK2([{/)yRX-aE'[;"%[btE*4AwY+B1]B.. %PDF-1.7 % Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The $150 co-payment is for a plain metal crown. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. H=o0w7S4oA2dhQ,QITEF}v@DN/8LBl^K]H*f:J]yDyS{dZ>L80|8xa@c7iCSY_yLdZ~2}e$LJV\+8CG09s^@wg8pn@\O9C3b\ O1^7TR6:'o9vS rp:QM{9l-k[[@szQV[*P/0chT}($^X'F-Bw)t]V[atF5]@R,hYxk,7Ge^AF*Ul. Bzb:5Gl8%bYYFMG`L"J/rrkBlF)ltPBVW oz 1-855-MET-EYE-1. 0000037280 00000 n Search for a dentist by name, specialty, ZIP code or the number of miles you are willing to travel. 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). Actual Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Periodontal maintenance is for patients whove previously had periodontal treatment. endstream endobj 4804 0 obj <>stream CPT only copyright 2015 American Medical Association. See Physician-related/professional services for information regarding vision exams and related services. The information you will be accessing is provided by another organization or vendor. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Others have four tiers, three tiers or two tiers.
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