If treatment is being given by a participating dental provider and the covered person asks for a more costly covered service than that for which coverage is approved, the specific copayment for such service will consist of: the copayment for the approved less costly service; plus This information is neither an offer of coverage nor medical advice. View Medicare Coverage & Benefits | Aetna Medicare Treating providers are solely responsible for medical advice and treatment of members. Blue Cross Blue Shield FEP DentalSM your coverage will begin on January 1, 2022. Provider Directory Last Updated: April 22, 2023 Page Last Updated: January 27, 2023 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. Dental | Prince George's County, MD Aetna Dental Direct insurance plan is offered by Aetna Life Insurance Company (Aetna). 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. Digital tools to easily manage your care and access your ID card whenever needed. Once youre a member, you have two ways to engage with your plan online. Information is believed to be accurate as of the production date; however, it is subject to change. The program does not make any payments to providers. Aetna offers two Dental PPO insurance plans to individuals and families, the Aetna Dental Direct Preferred and the Aetna Dental Direct Core. The ABA Medical Necessity Guidedoes not constitute medical advice. You get a broad choice of dentists and dental providers, wellness discounts and offers that stretch your health care dollar, digital tools to easily manage your care, and more. Some plans cover comprehensive services. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Please be sure to add a 1 before your mobile number, ex: 19876543210. Aetna does not provide dental, medical, vision or other health care/treatment. Aetna will expand the Total Choice dental benefit introduced in 2022 to additional Individual MA HMO-POS and PPO plans. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. Members should discuss any matters related to their coverage or condition with their treating provider. It does not meet the Minimum Creditable Coverage requirements in Massachusetts. Not available in many states. 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). It is only a partial, general description of plan or program benefits and does not constitute a contract. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Aetna Medicare dental plans: Coverage, eligibility, and costs 5. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Aetna Member Log-in Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. Thats it. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Teeth whitening and facings on molar crowns and pontics will always be considered cosmetic. Alternate Treatment Rule 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. 5 Visit AetnaMedicare.com to learn more about the 2022 Aetna Medicare plans. Remember Username Secure Login First time here? Get discounts on oral health care products like Z Sonic toothbrushes, replacement brush heads and various oral health care kits. By texting 90156, you consent to receive a one-time marketing automated text message from Aetna with a link to download the Aetna Health app. Please log in to your secure account to get what you need. 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. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. PGCPS pays 75% of monthly premium for dental, the PGCPS share increases to 80% after 8 years of service. Preventive services (cleaning, x-rays, exams, etc.) The three carriers providing service to the District's employees are CompBenefits/Humana (Basic and Enhanced PPO/Indemnity and DHMO Managed Care), Aetna (Basic and Enhanced PPO/Indemnity), and Aetna (Basic and Enhanced DHMO Managed Care). The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, close this message. It is not available in Montana, Vermont or Tennessee. Aetna Dental has over 50 years of experience offering dental benefits. *Acupuncture is an essential health benefit, and the discount for this service may duplicate benefits if you are enrolled in a full-service plan. Yes, I'm a memberNo, I'm looking for a plan. It is only a partial, general description of plan or program benefits and does not constitute a contract. PDF DMO Dental Benefits Summary Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). The amount of the discounts will vary depending on the provider and type of service or supply received. 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. You should: Review the Electronic Claim Vendor List Electronic Claim Vendor List. Is there a maximum dental benefit? Members should discuss any matters related to their coverage or condition with their treating provider. Copyright 2015 by the American Society of Addiction Medicine. Dental care, eyewear and hearing aids Many of our Medicare Advantage plans include dental, eyewear and hearing benefits. Certain preventive care services are covered at little-to-no-extra cost 2 when . ${tty} to chat about any Medicare questions you have. 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. Links to various non-Aetna sites are provided for your convenience only. There is one exception, however:If you needmedicaldental procedures whileyourein the hospital, Medicare may pay for those services as part of Medicare Part A (hospital insurance). The member's benefit plan determines coverage. 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. Aetna Medicare is a HMO, PPO plan with a Medicare contract. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. Links to various non-Aetna sites are provided for your convenience only. See the insurance policy for details. Replacement of teeth beyond the normal complement of 32 It's generally known as the Evidence of Coverage (EOC). Major services are covered at 50% with in-network providers (after deductible) Waiting periods for basic and major care waived with prior dental insurance No waiting periods for preventive services See any dentist, but you'll save more if you stay in network Annual Deductible $50 Per Person $150 Per Family, per calendar year Dental Coverage Through Work for Employees from Aetna | DMO & PPO Plans 2022 . Claims must be submitted within 365 days of the date you received the service. With Aetna Dental Direct, you'll get the coverage you need to keep your teeth healthy. 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. For more information, please call HSA Consulting Customer Service at (888) 978-8355. 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 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. You are now being directed to CVS Caremark site. Be sure to make copies of all of your paperwork. Links to various non-Aetna sites are provided for your convenience only. CPT is a registered trademark of the American Medical Association. *Actual costs and savings vary by provider and geographic area. 151 Farmington Avenue, Hartford, CT 06156. Altius Health Plans: HMO (PDF) - UT, ID (Southwest & Eastern), WY (Uinta County) HDHP (PDF) - UT, ID (Southwest & Eastern), WY (Uinta County) For information about our plans available through the Federal Employees Dental and Vision Insurance Program (FEDVIP), please visit our Dental PPO Plan site or our Aetna Vision Preferred plan site. Why choose ${company} Medicare Solutions? Dual Eligible Special Needs Plans (D-SNP). PLAN EXCLUSIONS AND LIMITATIONS* Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Choose from leading manufacturers and get free follow-up service for one year. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. This is only a summary of the plan's exclusions and limitations. Applicable FARS/DFARS apply. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. All Rights Reserved. We encourage you to check with your participating provider prior to beginning treatment. You pay up front for dental care and submit receipts for reimbursement. Use order code 123AET200. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. . 2022 Aetna Dental 2 Enroll at www.BENEFEDS.com . Network dentists offer special rates for covered services. Visit your PCD: If you see someone other than your selected PCD, you could end up paying more. Links to various non-Aetna sites are provided for your convenience only. Go to the American Medical Association Web site. Get coverage to any doctor (in or out-of-network) at the same member cost share. CPT is a registered trademark of the American Medical Association. How is coverage handled overseas? Very low rates. 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. Claim Submission Tips & Guidelines | Aetna Dental Contact Us | Aetna Dental Plans 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 2022 Medicare plans feature more benefits, lower member costs and Links to various non-Aetna sites are provided for your convenience only. The EOC is the legal contract between you and the Medicare plan. Give your member information at your visit. Includes PPO, HMO, HMO-POS medical plans with or without drugs. Premium deductions will start with the first full pay period Aetna Dental Savings Plans are NOT dental insurance and the dental savings will vary by provider, plan and zip code. This may be a copay, which is a set dollar amount. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. DISCOUNT OFFERS ARE NOT INSURANCE. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. When billing, you must use the most appropriate code as of the effective date of the submission. 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. They also have Direct Preventive, which only covers the costs of preventive dental care. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Verizon - Aetna Medicare Advantage Aetna Student HealthSM is the brand name for products and services provided by Aetna Life Insurance Company, Aetna Health and Life Insurance Company and their affiliated companies. 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.