Deductible applies to basic and major services only. When billing, you must use the most appropriate code as of the effective date of the submission. Network dentists offer special rates for covered services. 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 material is for information only. 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. Aetna Direct Core PPO comes with lower premiums, and Direct Preferred PPO provides more favorable splits in payment for basic procedures like fillings and extractions. See your Evidence of Coverage for details. . Switch by the 15th day of the current month. The plan offers preventive treatment at 100% with no out of pocket cost. Information is believed to be accurate as of the production date; however, it is subject to change. Applicable FARS/DFARS apply. Treating providers are solely responsible for dental advice and treatment of members. You may also be required to pay a portion of the costs. Surgical removal of impacted wisdom teeth when only for orthodontic reasons The amount of the discounts will vary depending on the provider and type of service or supply received. 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. 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). The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization. It's generally available starting in September and describes costs and benefits of your plan that will take effect on January 1 of the following year. To check that your provider participates, visit our website or call us. Im turning 65 or just starting to explore Medicare. Reprinted with permission. Aetna Dental plans come with special perks and discounts, including exclusive offers from CVS Health. Plan 41 Effective Date: 01-01-2022 Hampshire, Middlesex, Norfolk, Plymouth, Suffolk and Worcester. All services deemed "never effective" are excluded from coverage. We're here 8 a.m. - 8 p.m., Monday through Friday. Preventive services (cleaning, x-rays, exams, etc.) Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. With Aetna Dental Direct, youll get the coverage you need to keep your teeth healthy. Member Services: 1-877-238-6200 This information is neither an offer of coverage nor medical advice. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. Si tu intencin no era salir del sitio web, cierra este mensaje. Members must enroll in this option when they enroll in their plan, or within 30 days of their plans start date. Or it may be coinsurance, which is a percentage of the dentists charge. Replacement of a device or appliance that is lost, missing or stolen, and for the replacement of appliances that have been damaged due to abuse, misuse or neglect and for an extra set of dentures Aetna is continuing to expand the Aetna Dental PPO network across the country to . 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). 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 Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Cigna DPPO plan features 1. This may be a copay, which is a set dollar amount. You will receive the discount off the providers usual and customary fees when you pay. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. In case of a conflict between your plan documents and this information, the plan documents will govern. Purchasing the Aetna dental discount cards is easy - online, by mail or by phone. 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. This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. ** Out-of-network benefits are paid based on recognized charge levels, as determined by Aetna and specified in your plan documents. To learn more about using your Aetna MA dental benefits, read our guide below. App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google LLC. Please consult with the respective plan detail page for additional plan terms. 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). Preventive services such as cleanings, oral exams and X-rays are covered at 100 percent on most plans. You are leaving our Aetna Medicare website and going to an Aetna Medicaid website. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Instead, check your benefits summary to find your share of the costs. New and revised codes are added to the CPBs as they are updated. And you don't have to have Aetna medical or other coverage with us to purchase. The AMA is a third party beneficiary to this Agreement. If you do not intend to leave the Medicare site, close this message. 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). Cigna DPPO networks offer convenient access to quality dentists all across the country and savings on covered dental services. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Links to various non-Aetna sites are provided for your convenience only. For more info about your no-cost OneTouch BGM for Aetna Medicare plan members, you can visit us online or call 1-877-764-5390 ${tty} without a prescription. Links to various non-Aetna sites are provided for your convenience only. Get savings on weight-loss programs and meal plans, and enjoy one-on-one help, personalized menus, online tools and chat rooms. Your dental plan pays the rest. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Enrollment in this voluntary dental plan is open to all registered students and their eligible dependents. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Allow approximately 4-6 weeks for reimbursement. This search will use the five-tier subtype. Digital tools to easily manage your care and access your ID card whenever needed. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Important Disclaimers for Medicare Members For questions on your dental benefits, call us 1-866-409-0937 (TTY: 711). 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. For PPO plans and most HMO-POS plans, you have the option to go to any licensed provider, but could save money by using a provider in the network. Consent is not required to download the app. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Copyright 2015 by the American Society of Addiction Medicine. Aetna dental insurance comes with stand-alone dental coverage or dental, vision, and hearing coverage. You pay up front for dental care and submit receipts for reimbursement. As you age, maintaining your oral health is an important part of your whole-body wellness. Premium deductions will start with the first full pay period If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). Links to various non-Aetna sites are provided for your convenience only. This means you pay nothing out of pocket if you stay in network. One thing to keep in mind as you plan for dental care with this plan is that the cost of certain dental procedures and services can vary according to each provider. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. This Agreement will terminate upon notice if you violate its terms. 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. Save on gym memberships, health coaching, fitness gear, wearable fitness devices, group fitness on demand and more. Dental care is a vital part of maintaining yourhealth and well-being, especially as you age. If you do not intend to leave our site, close this message. Or log in to your member account to submit the form online. 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. If youre unable to print out the form, you can write out all the required information on a piece of paper and send it with your receipts. Brushing, flossing and getting regular dental checkups help to keep your mouth healthy. No deductible, no claims forms and no yearly dollar limits. 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. 1999- 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. Your InstaMed log in may be different from your Caremark.com secure member site log in. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. 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. Replacement of teeth beyond the normal complement of 32 Youre given an annual allowance to spend on dental care. This benefit maximum can range from about $150 to $6,000. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. The Aetna Vital Savings discount program is not insurance. 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. CPT only Copyright 2022 American Medical Association. CPT only copyright 2015 American Medical Association. No fee schedules, basic unit, relative values or related listings are included in CPT. Do you cover adult orthodontia? Print dental claim form (English) Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Get a discount on blood pressure montiors, pedometers, activity trackers, pain relief devices and other Omron products. 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. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Network dentists also file claims for you. Go to the American Medical Association Web site. 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. In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. 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. Please be sure to add a 1 before your mobile number, ex: 19876543210, Use our provider search tool to search, in the network, by name, specialty or procedure, See your benefits summary and get information about what's covered, Pull up your ID card whenever you need it. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.
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