Surgical removal of impacted wisdom teeth when only for orthodontic reasons New and revised codes are added to the CPBs as they are updated. Aetna Invisalign Coverage Your Aetna plan might cover your Invisalign treatment, although it depends entirely on the plan. 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). Tooth Missing But Not Replaced Rule Weve broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". . No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Links to various non-Aetna sites are provided for your convenience only. 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. To check that your provider participates, visit our website or call us. The member's benefit plan determines 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. Register Aetna Dental has over 60 years of experience offering dental benefits. All care is the responsibility of the treating provider, in consultation with the participant. Applicable FARS/DFARS apply. Some preferred provider organization (PPO) and health maintenance organization point-of-service (HMO-POS) plans, however, do allow you to see any licensed dental provider, but you may save money by seeing a provider in our network. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. 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. Aetna MAplans offer three types of dental benefits:network,direct memberreimbursementallowanceand optional supplemental benefits. SBBC now offers the option of four dental plans available from three dental carriers. All services deemed "never effective" are excluded from coverage. Dental plans are all different. 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. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 1999- For which you have no legal obligation to pay. ***Certain brands impose a no-discount policy. Aetna is continuing to expand the Aetna Dental PPO network across the country to . While most dental plans require a waiting period for major services like crowns or root canals, if you switch from your existing comparable plan to an Aetna plan, we will waive the waiting period. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. Provider Directory Last Updated: April 22, 2023 Page Last Updated: January 27, 2023 This may be a copay, which is a set dollar amount. With Aetna Dental Direct, youll get the coverage you need to keep your teeth healthy. Your dental plan pays the rest. Cons. When you see a dental care provider for services, you pay up front and get a receipt that includes a description of the services provided. That are provided by a family member. Links to various non-Aetna sites are provided for your convenience only. Learn more about our network and DMR plans Search other providers Need a provider directory? 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. Due to therelatively high out-of-pocket costs for these procedures, some older adultsend up forgoing necessary dental care. Print dental claim form (English) Check with your plan for more details. The SBC shows you how you and the plan would share the cost for covered health care services. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. CPT is a registered trademark of the American Medical Association. Aetna may receive a percentage of the fee you pay to the discount vendor. 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 information you will be accessing is provided by another organization or vendor. 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. Unlisted, unspecified and nonspecific codes should be avoided. Aetna Dental Direct | Secure Member Portal Login Secure Member Portal * required Username * Forgot Username? 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. How we make it simple for you About Medicare Advantage We're here to help you learn more about what you can get out of Medicare Advantage. Network dentists also file claims for you. Copyright 2015 by the American Society of Addiction Medicine. The member's benefit plan determines coverage. However, if you do this, you wont benefit from negotiated rates. In case of a conflict between your plan documents and this information, the plan documents will govern. 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. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. Annual Deductible $50 Per Person $150 Per Family, per calendar year, Annual Maximum Benefit $1,250 per covered person. Covered family members can choose their own PCDs. Are there any waiting periods? Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Alternate Treatment Rule CPT only Copyright 2022 American Medical Association. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. This material is for information only. Get coverage to any doctor (in or out-of-network) at the same member cost share. There also may be age and frequency limits on some services. Compare our plans and find the coverage that's best for you. CPT is a registered trademark of the American Medical Association. So your share of the cost is usually lower. This is donethrough an optional supplemental benefit. Aetna will continue to offer most Medicare Advantage members access to routine vision, dental and hearing coverage. ChooseHealthy is a federally registered trademark of ASH and used with permission herein. App Store is a service mark of Apple Inc. Android and Google Play are trademarks of Google LLC. Network dentists offer special rates for covered services. 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. To view the form just select Continue. Original Medicare, on the other hand, does not coverroutinedental care, such as cleanings, X-rays,andfillings. 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. The material is for information only. Your benefits plan determines coverage. Network dentists offer special rates for covered services. 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). 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. 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. Dental insurance plans are underwritten by Aetna Life Insurance Company. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). You may be balance billed by out-of-network dentists up to the dentists standard fee. There also may be age and frequency limits on some services. Dual Eligible Special Needs Plans (D-SNP). The Aetna HealthSM app and your Aetna member website are personalized, seamless and easy to use. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. Links to various non-Aetna sites are provided for your convenience only. Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). As of April 4, 2022, Medicare covers up to eight over-the-counter COVID-19 tests each month, at no extra cost to you if you have . Get the Aetna Health app by texting GETAPP to 90156 for a link to download the app and create an account. Knowing more about your plan can help you get the most from your benefits and covered services. Aetna makes no payment to the third parties you are responsible for the full cost. 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. Instruction for diet, plaque control and oral hygiene Everyone can get their own in-network primary care dentist. Treating providers are solely responsible for medical advice and treatment of members. Youll pay for your dental care up front when you see a dentist, and then submit your receipts to Aetna for reimbursement. This Agreement will terminate upon notice if you violate its terms. 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.
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