metlife dental fee schedule 2020 for providers

You can also view and share your digital ID card from the Aetna Health app. Orthodontia (adults and children) You pay 50% of covered services. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Your plan may have a coordination of benefits provision. Find a dentist near 2023 MetLife Services and Solutions, LLC 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. Our procedure fee tool provides participants of dental plans insured or administered by MetLife guidance in understanding your dental service providers fees. Visit the secure website, available through www.aetna.com, for more information. ;^{s4)|I6gPvJ=x ;j183 endstream endobj 780 0 obj <>/Metadata 30 0 R/Pages 777 0 R/StructTreeRoot 55 0 R/Type/Catalog/ViewerPreferences 798 0 R>> endobj 781 0 obj <>/MediaBox[0 0 612 792]/Parent 777 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 782 0 obj <>stream 0 WebDenteMax is one of the largest leasable dental PPO networks in the United States. Employees can choose between an extensive network of dentists and oral care specialists so they find a provider best suited for their needs. As the leading provider of dental benefits and largest commercial carrier, MetLife is committed to helping your employees maximize their benefits. I want information specifically for required under the federal Americans with Disabilities Act of 1990 hW[O8+~ CPT is a registered trademark of the American Medical Association. Signing up is simple and free. YN8e#'gxs4`T=>q{J&e-v%w+lC**hvD(5'-*GK v` 0000017092 00000 n 0000032811 00000 n 'u s1 ^ Exams are covered every six months (if using a participating dentist, there is a $15 co-payment). U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. endstream endobj 164 0 obj <>/Metadata 15 0 R/Pages 14 0 R/StructTreeRoot 17 0 R/Type/Catalog/ViewerPreferences<>>> endobj 165 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 -306.0 -396.0]>>/PageUIDList<0 152>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 166 0 obj [/Separation/PANTONE#20376#20C/DeviceCMYK<>] endobj 167 0 obj [/Separation/PANTONE#20347#20C/DeviceCMYK<>] endobj 168 0 obj [/Separation/PANTONE#202995#20C/DeviceCMYK<>] endobj 169 0 obj <> endobj 170 0 obj <>stream hbbd```b`` HW$WtM7GmFx4;c}""ztl3*_}"_^_Vkj*[iBK+i?n~/_-la6l{^}m>lq><9n?[{*w^G{e7+Q1V\tm8Vxp7%^t9u(28~Z6v{uf{T% 59Wv_[\}#=a.E1hqYM"8dT1!`9~]hGuDKGgyQ\knr[{tEr:Ad^KbP\9RuCn,sSvjkP(G#OJt3ooQc 1(*@v Questions may be directed to Humana provider relations by calling 1-800-626-2741, Monday Friday, 8 a.m. 5 p.m., Central time. endstream endobj startxref 0000136750 00000 n hb``d``c``e`kgg@ ~'a >/*g3,>Ib1h(ettt4@ ceY %PDF-1.7 % 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. 0000020858 00000 n CPT only copyright 2015 American Medical Association. Log in to find a dentist who accepts your coverage. It is only a partial, general description of plan or program benefits and does not constitute a contract. 206 0 obj <>stream All Rights Reserved. WebMetLife has the largest range of dental insurance plans and providers among dental insurance organizations. If you need interpretation services and are enrolled in the Preferred Dentist Program (Dental 0qPWp:dW5 ;6V]BpJ#@DE"?Fo=+57]>>=@^{"p5yM~'A}t`)6ts(T^ `p]~@5zPn/VO=RB;#Gkj@!bg~7s}f DMO plans require a surgical periodontal history. See Physician-related/professional services.). WebDelta Dental has the largest network of dentists nationwide. Find your dentist now in Aetnas large nationwide network. 0000072473 00000 n Discover the best option: HMO, PPO and TakeAlong Dental Copyright 2015 by the American Society of Addiction Medicine. 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. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. The information you will be accessing is provided by another organization or vendor. Spell out street names and abbreviations (State Highway 249 instead of SH 249). This applies to services for: For more details, review your plan documents. Contact Us. 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. Refer to the current Physician-related/professional services for information regarding blood, blood products, and related services. Plus, you'll enjoy: More than 400 covered services 2. Or call Member Services for coverage details. %PDF-1.7 % This search will use the five-tier subtype. *Illinois members: State laws vary with regard to out-of-network benefits. 825 0 obj <>stream Disclaimer of Warranties and Liabilities. 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. \-.m\EqYt0.\fj JR This is called an extension of benefits provision. WebLike most group benefits programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, waiting periods, reductions of benefits, limitations w)A7ilBnx_^bu>3E;LU,Nhs%v1&OvC:-R/mTpm:3]q%ih*N If so, the primary care doctor will arrange it. CPT is a registered trademark of the American Medical Association. See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page. How are claims For questions about rates or fee schedules, email ProfessionalRates@hca.wa.gov. Register and log in to your member website. hbbd```b``v> >d(XM|&c0L*e$li6"A@Lg` hT Each main plan type has more than one subtype. Most PCDs treat children and can refer members to a pediatric dentist, if necessary. If you do not intend to leave our site, close this message. Links to various non-Aetna sites are provided for your convenience only. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Our clients of insurance companies, third-party administrators and various groups lease the DenteMax PPO network for use in their dental benefit plans in order to service their more than 20 million members nationwide. m-4f'f{">H746Z5apg`u0? 0000016556 00000 n 163 0 obj <> endobj Visit our Forms and publications page to download authorization forms. The secondary plan acts like a supplement to the primary plan. endstream endobj 4801 0 obj <>stream In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. endstream endobj startxref WebAll Other Dental Services You Pay $0 In-Network $50 Out-of-Network $50 The maximum amount Guardian will reimburse you for dental services received Limitations and Exclusions (see your policy for further details) We will not pay Links to various non-Aetna sites are provided for your convenience only. HOO1sj^ !CHTww`]%6x7A|!! The ABA Medical Necessity Guidedoes not constitute medical advice. Please contact Member Services. January 1, 2023 to present Dental program fee schedule (updated January 26, 2023) Hn0R`~(dQQl\0H5oKtFA?v>4.zL >.K;J+p0eLK!YWU-`}\~nxqC79*G: >$LAFMEECJ.&rwBx77C(gOI CHAwl"4Q !b p^y2gp#M Or it will be a flat dollar amount (copay). Just go to the Apple App Store or Google Play Store. See Physician-related/professional services for information regarding vision exams and related services. n[F$6_KZi4k Visit our Document submission cover sheets page to find the barcode cover sheets required with additional documentation. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. (For example, if you change your PCD on April 15, the change will take effect May 1. Therefore, it is crucial to verify benefits and eligibility with the Payor. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Orthodontic treatment from a participating provider doesnt require referrals. Before you provide certain services, you will need to submit authorization request forms. 0000000016 00000 n Unlisted, unspecified and nonspecific codes should be avoided. For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page. However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Questions? Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Under these circumstances, dental offices may see the need to adjust their fee schedules. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). )SI{ 0BO|cEs}Oq""TV}c`u-hSwi8J", Predeterminations may not be available in all states. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Aetna's 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). We need to authorize the use of a different provider before treatment. 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. Periodontal maintenance is for patients whove previously had periodontal treatment. "H9 !dQ &`,[f*#@$c VvDxAl@&FY`)g c 0000039476 00000 n WebJuly 1, 2022 to present Mobile anesthesia for dental services billing guide; Fee schedules. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 0000037929 00000 n 0000017206 00000 n 0000001499 00000 n P|!(}!h}qsPq!F#($FikLuJs?nSG^w;jp*B3&x!W x}k}l~'W)+~KZnsN1MVqy G8O,'"Gg Q All agency-contracted managed care organizations (MCOs) and the fee-for-service (FFS) program use the Apple Health PDL. 0000036485 00000 n 0000038707 00000 n Contact Member Services if you have questions. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product. endstream endobj 4795 0 obj <>stream These rules determine You must contact us. 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. This information is neither an offer of coverage nor medical advice. Please be sure to add a 1 before your mobile number, ex: 19876543210, Coinsurance You pay a percentage of covered expenses, Crowns and fixed bridgework when the teeth were prepared before your Aetna coverage began, Appliances (such as dentures) when the impression was taken before your Aetna coverage began, Root canal therapy when the tooth's pulp chamber was opened before your Aetna coverage began.

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