Choose a category below to see questions and answers about Dental Maintenance Organization (DMO) coverage. If not, we will pay as the secondary payor. 2023 MetLife Services and Solutions, LLC 1s a5S q b6L4 . Refer to the current Physician-related/professional services for information regarding blood, blood products, and related services. 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. Oral surgery You pay 20% of covered services for basic surgery; 50% of covered major surgery. 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. Use our billing guides and fee schedules to determine if a PA is required and assist in filing claims. HTn0?N$vt.taQ"]QI~}kGvc:PXJ
,DDIuEE}%uDp'QMXzm:h?cZH;%*E[*& WebYikes, something went terribly wrong!!!
Provider Forms and Downloads Hn0R`~(dQQl\0H5oKtFA?v>4.zL >.K;J+p0eLK!YWU-`}\~nxqC79*G: >$LAFMEECJ.&rwBx77C(gOI CHAwl"4Q !b p^y2gp#M
Provider Quick Reference Guide 0000050717 00000 n
L0621014064[exp0622][All States]. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 0000044288 00000 n
Your benefits dont double if you are enrolled in two dental plans.
Dental Your benefits plan determines coverage. 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. endstream
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Orthodontic treatment from a participating provider doesnt require referrals. It describes the services you have coverage for under your plan. Find individual dental insurance plans near you with budget-friendly coverage options and get a quote. The Apple Health PDL can be found on the agency's Apple Health PDL page. You may choose a new one once a month. When you go to or call the dentist, tell the office staff that you have Aetna Dental DMO. G!Qj)hLN';;i2Gt#&'' 0
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. For fee schedule and rate questionsEmail:
[email protected], 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. This means if you have two plans that cover two cleanings per year, you dont have four cleanings per year. Or call Member Services at the number on your ID card. *Illinois members: State laws vary with regard to out-of-network benefits. How do I notify PEBB that my loved one has passed away? Find a dentist near 0000050892 00000 n
Provider billing guides and fee schedules - Washington HtTYo@~0IOHC How do I notify SEBB that my loved one has passed away? Members should discuss any matters related to their coverage or condition with their treating provider. Applicable FARS/DFARS apply. endstream
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Include North/South/East/West with address if appropriate. There are several types of coordination of benefits provisions. WebYikes, something went terribly wrong!!! 0000038707 00000 n
Some plans exclude coverage for services or supplies that Aetna considers medically necessary. This applies to services for: For more details, review your plan documents. 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. CPT is a registered trademark of the American Medical Association. WebCan I get an estimate of my out-of-pocket expenses? For telehealth policies and FAQs, see Telehealth on this page. If so, we will confirm which plan has primary responsibility for claim payment. 0000044706 00000 n
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%. How do providers identify the correct payer? 0000017092 00000 n
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Your and Your (For example, if you change your PCD on April 15, the change will take effect May 1. 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. RLaVHQB-JS=*ccYqE,cD98q:A-H}D+&\jC80n 3"Dtd(DDhy
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;{ycu$g@y&A|d(:6e FkG=^:s`P$aq/lX}N970/k 0000017206 00000 n
0000029561 00000 n
Call Customer Service at H|y\GozfKQgxDxk5Q"E[/P# GYf>WWU]z #Fv;t|*DDG&)07"jnlM&r3fLIsg@L?2t&&:r@p>_hwxwm!1IcNp,<6nfT^IAI. The member's benefit plan determines coverage. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. New and revised codes are added to the CPBs as they are updated. WebDental insurance helps you plan for the costs of dental care. endstream
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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. This will let you and the dentist know what the benefit will be if the service is done. Sign up at BeneFeds.com or call 1-877-888-3337. 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. QyJh6,j9nsm WL Ogf8jN%7}0Q_%uSiz7XtyLs^14(.x While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Contact Us. endstream
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Discover the best option: HMO, PPO and TakeAlong Dental hb``d``c``e`kgg@ ~'a >/*g3,>Ib1h(ettt4@ ceY Please see your plan documents. Search our network GEHA's 2023 Dental Benefits Need help choosing a plan? Most PCDs treat children and can refer members to a pediatric dentist, if necessary.
Ooops!!! - MetLife 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. 163 0 obj
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Benefits provided by SafeGuard Health Plans, Inc., a MetLife company. You can also contact Member Services to determine if they are eligible under your DMO plan. YN8e#'gxs4`T=>q{J&e-v%w+lC**hvD(5'-*GK v`
w)A7ilBnx_^bu>3E;LU,Nhs%v1&OvC:-R/mTpm:3]q%ih*N For previous versions, email us
[email protected]. It is only a partial, general description of plan or program benefits and does not constitute a contract. 0000072009 00000 n
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. WebWe would like to show you a description here but the site wont allow us. 797 0 obj
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If you do not intend to leave our site, close this message. CPT only copyright 2015 American Medical Association. You are now being directed to CVS Caremark site. 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. Members cant choose a pediatric dentist as their PCD. endstream
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Fee Lookup %%EOF
The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. n[F$6_KZi4k See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page. Visit our Forms and publications page to download authorization forms. 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. Unlisted, unspecified and nonspecific codes should be avoided. Therefore, it is crucial to verify benefits and eligibility with the Payor. endstream
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Others have four tiers, three tiers or two tiers. Yes, but some plans may limit the benefit to certain teeth. This SCHEDULE OF BENEFITS lists the Covered Services available to You and Your Dependents under Your dental plan, as well as Your and Your Dependents costs for each Covered Service.
Payments Information Dental Insurance Center - MetLife Dental 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.
Metlife - Member Dental Plan Benefits - Member Benefits DNO (Dental Network Only) in Virginia is not an HMO. What you pay will be based on a percentage of those charges (coinsurance). endstream
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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. WebFind a Dentist. You can find a network dentist with our online directory. ? 0000025338 00000 n
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 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. 0000016913 00000 n
os yI"f]Ez| y n1|8(AV0jxU&hz=Hw
9\VMwwh!B lsJB&)C|N!!Xr&K{k9i[MU[oKSk&X2EUxkvlM~W For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide. For questions about rates or fee schedules, email
[email protected]. Register and log in to your member website. They arent a PCD. Check your plan documents or call Member Services for details. Mk6 }gm QxXs|'5jjr8`deWkh2-a!-q$uz`z78KPM^}BH*Ifv%\P$^E
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Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). If we have primary responsibility, we will pay as the primary payor. MetLifes Preferred Provider Organization (PPO) plans feature the MetLife Preferred Dentist Program, which is designed to save you money on dental services.1 You can choose from thousands of participating general dentists and specialists nationwide. rxo
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Enter the street name or intersection instead of address numbers (24th and Broadway instead of 2432 Broadway). Ho0?4$#UVCr!bf! B[@U=7Y>6.vf 0000113149 00000 n
Please contact Member Services. Have your dentist send a pretreatment estimate (predetermination) to us. 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.
MetLife Applicable FARS/DFARS apply. endstream
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You can get a Summary of Benefits from your employer that provides your insurance. Virginia members: In Virginia, DMO is called DNO (Dental Network Only). If so, the primary care doctor will arrange it. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. WebSchedule of Benefits . "H9 !dQ &`,[f*#@$c
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This search will use the five-tier subtype. Hn0}
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Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. _t These services include: We may not cover services youve received without coverage. WebNot all employer groups associated with these Payors will utilize the Connection Dental Network. WebBoth of our dental plans include: Comprehensive dental services, from preventive care to crowns, bridges and dentures No in-network deductibles and no waiting periods, including orthodontia for children and adults Worldwide coverage with a large nationwide network. Notice: Past billing guides may have broken links. Hn@})R$R(8I1$o0Z?IT @m$,RRW$_yV? 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. xref
Predeterminations may not be available in all states. 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. It sets what they can charge for covered services. You may not have coverage to replace teeth that were lost or extracted before your coverage began. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. 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. cy 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. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Depending on your plan, you may pay for dental care in one of two ways: There are no deductibles or annual dollar maximums. By clicking on I Accept, I acknowledge and accept that: The Applied Behavior Analysis (ABA) Medical Necessity Guidehelps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Periodontal maintenance is for patients whove previously had periodontal treatment. 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. This Agreement will terminate upon notice if you violate its terms. 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). This is called an extension of benefits provision. Check your Aetna Summary of Benefits. 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). Verify the spelling of the street name or city. 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. Some subtypes have five tiers of coverage. trailer
Some plans exclude coverage for services or supplies that Aetna considers medically necessary. WebYou may choose one of four dental plans, offered by SafeGuard, a MetLife Company and Metropolitan Life. 0000020858 00000 n
Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Direct Referral Dental Plan* MET185A. 0
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Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. We need to authorize the use of a different provider before treatment. MetLife Vision contracted providers allow full and equal
Fee Schedules After you complete a service, you file claims through the ProviderOne portal.
Find a Vision Provider - mymetlifevision.com 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. {YO2GMP!BJMP(!/(q@>6 0 1
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