However, if you do this, you wont benefit from negotiated rates. Aetna handles premium payments throughInstaMed, a trusted payment service. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Language services can be provided by calling the number on your member ID card. Aetna Inc. and its subsidiary 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. Go to the American Medical Association Web site. Important Disclaimers for Medicare Members For questions on your dental benefits, call us 1-866-409-0937 (TTY: 711). They also have Direct Preventive, which only covers the costs of preventive dental care. If you have questions about your Medicare plan, start here. 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 Some plans will cover around 50% of adult orthodontic treatment (including Invisalign), while others will only cover children up to 19 years old. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. You may be balance billed by out-of-network dentists up to the dentists standard fee. As you age, maintaining your oral health is an important part of your whole-body wellness. 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. 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. For prescribed drugs, pre-treatments or analgesia. Want to see options for a different location? For language services, please call the number on your member ID card and request an operator. Premium deductions will start with the first full pay period There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. 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. Consent is not required to download the app. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Alternate Treatment Rule Once youre a member, heres how you can connect: 1. When billing, you must use the most appropriate code as of the effective date of the submission. 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. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. 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. All Rights Reserved. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. Member Services: 1-877-238-6200 You can also download it from the App Store or the Google PlayTM store. Unlisted, unspecified and nonspecific codes should be avoided. Participating dentists have agreed to provide services at a negotiated rate for covered services. Aetna is continuing to expand the Aetna Dental PPO network across the country to . CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Temporomandibular joint dysfunction/disorder. Visit any licensed dentist outside the network. The SBC shows you how you and the plan would share the cost for covered health care services. See dentists both in and out of our network. 4. . The following information is about the Aetna Medicare Choice Plan (PPO) formulary (or drug list). If you have more questions, just call us at 1-866-241-0356 (TTY: 711), Monday through Friday, 8 AM to 9 PM ET. Do you want to continue? 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). *Based on January 2023 Aetna provider data Save on popular designer frames*** and vision items that dont need a prescription. You can visit national chains and thousands of doctors in private practice. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Treating providers are solely responsible for medical advice and treatment of members. In Pennsylvania, the waiting period is called an elimination period and most Basic services have one month waiting period. The dental discounts are available through participating healthcare providers only. For example, you pay 20%, and your plan pays 80%. Aetna Medicare SM Plan (PPO) Learn more about Aetna Feeling Good: Your Verizon Aetna magazine Check out Feeling good , the magazine created specifically for Verizon Aetna members. 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. This information is neither an offer of coverage nor medical advice. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. This is only a summary of the plan's exclusions and limitations. Get lower rates when you go to a dentist thats in your PPO network. Reprinted with permission. Preventive services (cleaning, x-rays, exams, etc.) Links to various non-Aetna sites are provided for your convenience only. CPT is a registered trademark of the American Medical Association. If you enroll in an Aetna Medicare Advantage plan that includes dental coverage, some of the services that may be covered include: Teeth cleaning, scaling and polishing Office visits for oral examinations Non-surgical extractions Fillings Minor denture adjustments X-rays Oral hygiene instruction Dietary advice and counseling Minor bite adjustments 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. 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. Others have four tiers, three tiers or two tiers. 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. Links to various non-Aetna sites are provided for your convenience only. 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). 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). Caring for your teeth should never feel out of reach with Aetna Dental Direct. Knowing more about your plan can help you get the most from your benefits and covered services. For someAetna MA plansthatdontincludedental coverage, you mayhave the choiceof payingextra each month for dental benefits. You may pay more when you get care from dentists who arent in the network.**. Not available in many states. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. To learn more about using your Aetna MA dental benefits, read our guide below. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". So, your share of the cost is usually lower. Network dentists offer special rates for covered services. This Aetna Dental Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. Links to various non-Aetna sites are provided for your convenience only. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Each main plan type has more than one subtype. Dental care is a vital part of maintaining yourhealth and well-being, especially as you age. Links to various non-Aetna sites are provided for your convenience only. Dental insurance plans are underwritten by Aetna Life Insurance Company. Some subtypes have five tiers of coverage. Information is believed to be accurate as of the production date; however, it is subject to change. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Aetna offers two Dental PPO insurance plans to individuals and families, the Aetna Dental Direct Preferred and the Aetna Dental Direct Core. Rates start at $7.99 a month. 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. Links to various non-Aetna sites are provided for your convenience only. You also have the flexibility to visit a licensed dentist who does not participate in our network. New and revised codes are added to the CPBs as they are updated. 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. Crown, inlays and onlays, and veneers unless for one of the following: How to enroll: Members must make payments directly to the providers in the Aetna Vital Savings program. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. 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. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. CPT is a registered trademark of the American Medical Association. Section 5 Dental Services and Supplies Class A Basic 16 . You can choose from one of the more than 420,000 dentist locations in the Aetna Dental PPO network. 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. A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and .