You can also download it from the App Store or the Google PlayTM store. 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. 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. Once youre a member, you have two ways to engage with your plan online. You are now being directed to CVS Caremark site. In case of a conflict between your plan documents and this information, the plan documents will govern. This may be a copay, which is a set dollar amount. That are not medically necessary. 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. 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. Deductible: the dollar amount some plans require you to pay for services before coverage starts. When billing, you must use the most appropriate code as of the effective date of the submission. If you do not intend to leave our site, close this message. While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. So your share of the cost is usually lower. For prescribed drugs, pre-treatments or analgesia. Special perks and discounts, including exclusive offers from CVS Health, Search for providers in-network by using our. Treating providers are solely responsible for medical advice and treatment of members. Crown, inlays and onlays, and veneers unless for one of the following: We make dental care convenient. 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. Links to various non-Aetna sites are provided for your convenience only. Certain preventive care services are covered at little-to-no-extra cost 2 when . Disclaimer of Warranties and Liabilities. This is donethrough an optional supplemental benefit. Register If you do not intend to leave our site, close this message. The SBC shows you how you and the plan would share the cost for covered health care services. They are not benefits under your insurance plan. Pay less for acupuncture,* chiropractic visits, therapeutic massage and nutrition services** and for products like wearable fitness devices and fitness kits. With Aetna Dental Direct, you'll get the coverage you need to keep your teeth healthy. CPT only copyright 2015 American Medical Association. You can choose from one of the more than 420,000* dental providers nationwide. The school has chosen a plan that makes it easy to keep your smile. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. See your Evidence of Coverage for details. Aetna Dental has over 50 years of experience offering dental benefits. 5. Get savings on weight-loss programs and meal plans, and enjoy one-on-one help, personalized menus, online tools and chat rooms. You can start using your plan right away! Save on gym memberships, health coaching, fitness gear, wearable fitness devices, group fitness on demand and more. 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. Aetna Dental Direct PPO Plans are Subject to the Following Rules: Replacement Rule Caring for your teeth should never feel out of reach with Aetna Dental Direct. Premium deductions will start with the first full pay period 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. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. The ABA Medical Necessity Guidedoes not constitute medical advice. That are cosmetic in nature. The Aetna Vital Savings discount program is not insurance. You may also have to file your own claims. Network dentists also file claims for you. 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. By submitting your information you are agreeing to receive communications from Aetna Dental Offers. Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Digital tools to easily manage your care and access your ID card whenever needed. Aetna Medicare Advantage HMO-POS plans. Language services can be provided by calling the number on your member ID card. CPT is a registered trademark of the American Medical Association. Claim FAQ. Knowing more about your plan can help you get the most from your benefits and covered services. Shop around different dental care providers in your area to compare costs and make the best use of your annual allowance. Instead, check your benefits summary to find your share of the costs. Temporomandibular joint dysfunction/disorder. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 2022 - 2023 Aetna PPO Dental Plan Design and Benefits Summary. Message and data rates may apply.***. Why choose ${company} Medicare Solutions? Cigna DPPO plan features 1. You also have the flexibility to visit a licensed dentist who does not participate in our network. This means you pay nothing out of pocket if you stay in network. your primary care dentist will refer you to one in our network. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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. SBBC now offers the option of four dental plans available from three dental carriers. If your MA plan doesnt include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits for an additional monthly premium. Applicable FARS/DFARS apply. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Actual costs and savings may vary by provider, service and geographic location. Dental plans are all different. 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). All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. However, if you do this, you wont benefit from negotiated rates. So, you wont see cost information here. Since Dental Clinical Policy Bulletins (DCPBs) 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. Aetna handles premium payments throughInstaMed, a trusted payment service. Youcansee anylicenseddental provider in the U.S. You can use the allowance toward almost all dental services except for teeth whitening and a few administrative costs (e.g., missed appointments). New and revised codes are added to the CPBs as they are updated. Deductible applies to basic and major services only. CPT only Copyright 2022 American Medical Association. 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. The following information is about the Aetna Medicare Choice Plan (PPO) formulary (or drug list). The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. your coverage will begin on January 1, 2022. 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. Caremark.com is the secure website where Aetna Medicare SilverScript members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options. 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. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). Aetna dental insurance comes with stand-alone dental coverage or dental, vision, and hearing coverage. 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. No claims or paperwork for in-network care. The member's benefit plan determines coverage. Do you want to continue? Enrollment in this voluntary dental plan is open to all registered students and their eligible dependents. If you are already an Aetna Dental Insurance Member and have a question regarding your existing policy or claim, please visit Aetna.com or call 1-800-872-3862 I have a question about billing Topic* Please select a topic for your inquiry Billing Question Other The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. Applicable FARS/DFARS apply. 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. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. The employee pays the remainder through payroll deduction Premiums are deducted on a pre-tax basis Contact Information at Aetna Customer Service 1-877-238-6200 or www.aetna.com About the Plan Aetna Dental Summary - Effective January 1, 2023 The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Is there a maximum dental benefit? 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. Claims must be submitted within 365 days of the date you received the service. Information is believed to be accurate as of the production date; however, it is subject to change. Print and fill out the reimbursement form. All Rights Reserved. Visit your PCD: If you see someone other than your selected PCD, you could end up paying more. You can choose from thousands of dental providers nationwide, including those who offer virtual dental visits. Legal notices 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). Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. In Pennsylvania, the waiting period is called an elimination period and most Basic services have one month waiting period. CPT is a registered trademark of the American Medical Association. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Replacement of teeth beyond the normal complement of 32 Purchasing the Aetna dental discount cards is easy - online, by mail or by phone. 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. Copyright 2015 by the American Society of Addiction Medicine. THIS IS A SUMMARY ONLY AND DOES Do you cover implants? Dental network Direct Member Reimbursement (DMR) Not sure If you're covered through a former employer, union, trust or other retirement system, then you have a dental network plan and are covered by the Aetna Dental PPO network. Aetna Medicare is a HMO, PPO plan with a Medicare contract. Aetna handles premium payments through InstaMed, a trusted payment service. 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. You are leaving our Aetna Medicare website and going to an Aetna Medicaid website. The Appointment of Representative form is on CMS.gov. How is coverage handled overseas? 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. These typically include some level of dental coverage, including twice-yearly oral health exams, teeth. Select a state below to update coverage details. All three plans are available in all 50 states and D.C and feature increased formulary coverage from 2022. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. In excess of the benefit, dollar, day, visit, or supply limits stated in your schedule of benefits. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Dental care is a vital part of maintaining yourhealth and well-being, especially as you age. But do you know that your oral health is linked to many medical conditions? 2022 A Nationwide Dental PPO Plan IMPORTANT Rates: Back Cover Changes for 2022: Page 4 . Out of network: Others have four tiers, three tiers or two tiers. New and revised codes are added to the CPBs as they are updated. 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. Dental benefits and dental insurance plans contain exclusions and limitations. Links to various non-Aetna sites are provided for your convenience only. *Actual costs and savings vary by provider and geographic area. The information you will be accessing is provided by another organization or vendor. Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Reprinted with permission. 2022 . You pay up front for dental care and submit receipts for reimbursement. You can choose from one of the more than 420,000 dentist locations in the Aetna Dental PPO network. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other health care professional. - It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material When billing, you must use the most appropriate code as of the effective date of the submission. Others have four tiers, three tiers or two tiers. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. Tooth Missing But Not Replaced Rule 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. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. This Agreement will terminate upon notice if you violate its terms. Print dental claim form (English) Aetna does not endorse any vendors, products or services associated with this program. Your out of pocket expenses will be higher if you do not see an in-network provider and, in some plans, benefits may not be available at all for out-of-network providers. It's generally known as the Evidence of Coverage (EOC). The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. 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.
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