Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. You are leaving our Aetna Medicare website and going to an Aetna Medicaid website. Members must make payments directly to the providers in the Aetna Vital Savings program. General anesthesia and intravenous sedation, unless specifically covered and only when done in connection with another eligible dental service There also may be age and frequency limits on some services. Understanding Medicare Advantage Dental Benefits | Aetna 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. But your plan features and costs will vary depending on the plan you choose. Use order code 123AET200. Your dental plan may have yearly and lifetime limits on coverage. With a PPO plan, you can visit any dentist you want (whether they are in or out of the network) and usually receive some coverage level. 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. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). This search will use the five-tier subtype. Aetna Dental Direct Preferred PPO Plan | DentalPlans.com It does not meet the Minimum Creditable Coverage requirements in Massachusetts. 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. You also have the flexibility to visit a licensed dentist who does not participate in our network. Go to the American Medical Association Web site. For example, you pay 20%, and your plan pays 80%. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). The replacement of; addition to; or modification of: existing dentures; crowns; casts or processed restorations; removable denture; fixed bridgework; or other prosthetic services is covered only if specific criteria are met. Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). You can find a network provider by logging in as a member and going to our provider directory. When you have an Aetna Dental plan, you know youre taking the right steps toward being healthy. Applicable FARS/DFARS apply. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. 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. When billing, you must use the most appropriate code as of the effective date of the submission. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. Our plan selection pages will be down for maintenance starting Friday, April 16, at 9 p.m. and returning by 1 p.m. Saturday, April 17. Get discounts on oral health care products like Z Sonic toothbrushes, replacement brush heads and various oral health care kits. Studies show that a healthy mouth helps you avoid health problems in the body, too. View your plan - Verizon - Aetna Medicare Advantage Find the right plans and programs for you. Some of the covered dental services may include (be sure to check with your plan for details): If you have network or OSB coverage, you may be limited to a specific number of services per year. 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. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. DISCOUNT OFFERS ARE NOT INSURANCE. Please consult with the respective plan detail page for additional plan terms. So, your share of the cost is usually lower. Special perks and discounts, including exclusive offers from CVS Health, Search for providers in-network by using our. Once youre a member, heres how you can connect: 1. Aetna 2022 Medicare plans feature more benefits, lower member costs and By clicking on I accept, I acknowledge and accept that: Licensee's use and interpretation of the American Society of Addiction Medicines ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits. Aetna Dental plans come with special perks and discounts, including exclusive offers from CVS Health. All care is the responsibility of the treating provider, in consultation with the participant. No fee schedules, basic unit, relative values or related listings are included in CPT. Weve broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips. Preventive services such as cleanings, oral exams and X-rays are covered at 100 percent on most plans. PLAN EXCLUSIONS AND LIMITATIONS* The SBC shows you how you and the plan would share the cost for covered health care services. The information you will be accessing is provided by another organization or vendor. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Treating providers are solely responsible for dental advice and treatment of members. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Get savings on weight-loss programs and meal plans, and enjoy one-on-one help, personalized menus, online tools and chat rooms. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Digital tools to easily manage your care and access your ID card whenever needed. New and revised codes are added to the CPBs as they are updated. Deductible applies to basic and major services only. Out of network: If you have questions about your Medicare plan, start here. For prescribed drugs, pre-treatments or analgesia. The AMA is a third party beneficiary to this Agreement. To check that your provider participates, visit our website or call us. Im turning 65 or just starting to explore Medicare. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. That would not be made if you did not have coverage. If your plan doesnt include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits with an additional monthly premium (coverage varies by plan). For comprehensive services, such as fillings, extractions and crowns, the coverage varies according to plan, and you may have to pay a portion of the cost of 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. Coverage for the first installation of removable dentures; fixed bridgework and other prosthetic services is subject to the requirements that such removable dentures, fixed bridgework and other prosthetic services are: needed to replace one or more natural teeth that were removed while this policy was in force for the covered person; and are not abutments to a partial denture; removable bridge; or fixed bridge installed during the prior 8 years. Section 5 Dental Services and Supplies Class A Basic 16 . Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. The information you will be accessing is provided by another organization or vendor. This information is neither an offer of coverage nor medical advice. Whether youre at your desk or on the go, our easy-to-use digital tools help you manage your dental plan, save money and make smart decisions about your care. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 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. Privacy policy: Aetna.com/legal-notices/privacy.html. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. We've broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. 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. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. You may also be required to pay a portion of the costs. 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. Best Dental Insurance Plans for Seniors in 2023 - The Senior List Save on gym memberships, health coaching, fitness gear, wearable fitness devices, group fitness on demand and more. Visit your PCD: If you see someone other than your selected PCD, you could end up paying more. Unlisted, unspecified and nonspecific codes should be avoided. 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). ** Out-of-network benefits are paid based on recognized charge levels, as determined by Aetna and specified in your plan documents. Provider Directory Last Updated: April 22, 2023 Page Last Updated: January 27, 2023 Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Claim Submission Tips & Guidelines | Aetna Dental The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Vision and hearing at no additional cost. Members should discuss any matters related to their coverage or condition with their treating provider. Aetna Dental has over 50 years of experience offering dental benefits. Medicare Hearing Aids, Dental Coverage, & Eyewear - Aetna This site has its own log in. . Aetna Dental PPO Please call them at the number on your member ID Card or at 877-480-4161 from 8:30 a.m.-5:30 p.m, Mon-Fri. Direct member reimbursement allowance: How to get reimbursed for dental care. Insurer Name: Aetna Life Insurance Company Plan Name: Aetna Dental PPO Policy Type: PPO Insurer Phone #: 1-877-238-6200 Effective Date: 01/01/2022-12/31/2022 Insurer Website: www.aetna.com THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND WHAT YOU WILL PAY FORCOVERED SERVICES. The material is for information only. Note not all Aetna dental plans and offers available in all markets. Aetna dental insurance comes with stand-alone dental coverage or dental, vision, and hearing coverage. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Please be sure to add a 1 before your mobile number, ex: 19876543210. 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. Visit the secure website, available through www.aetna.com, for more information. This Agreement will terminate upon notice if you violate its terms. If you do not intend to leave our site, close this message. Links to various non-Aetna sites are provided for your convenience only. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Aetna Inc. and its affiliated 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. This may be a copay, which is a set dollar amount. 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. You are now being directed to the CVS Health site. Annual Deductible $50 Per Person $150 Per Family, per calendar year, Annual Maximum Benefit $1,250 per covered person. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors). So your share of the cost is usually lower. Why choose ${company} Medicare Solutions? CPT is a registered trademark of the American Medical Association. The plan offers preventive treatment at 100% with no out of pocket cost. Aetna Dental Direct | Secure Member Portal Login Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. The ABA Medical Necessity Guidedoes not constitute medical advice. Enrollment in this voluntary dental plan is open to all registered students and their eligible dependents. Language services can be provided by calling the number on your member ID card. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Aetna Dental Coverage | New York State Nurses Association All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. Dental network Direct Member Reimbursement (DMR) Not sure If you're covered through a former employer, union, trust or other retirement system, then you have a dental network plan and are covered by the Aetna Dental PPO network. 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 Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. 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. Aetna handles premium payments through InstaMed, a trusted payment service. Aetna is continuing to expand the Aetna Dental PPO network across the country to . Check your benefits summary, so youll know what to pay. 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. It gives members access to discounted fees according to schedules negotiated with providers by Aetna Life Insurance Company for Aetna Vital Savings. This Agreement will terminate upon notice if you violate its terms. For language services, please call the number on your member ID card and request an operator. Aetna Dental Direct PPO Plans are Subject to the Following Rules: Replacement Rule Applicable FARS/DFARS apply. 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).
Cessna 150 Composite Prop,
What Does Hpv Odor Smell Like,
Social Science Issues Related To War,
Morris Hills High School News,
Articles A
