metlife dental fee schedule 2020 for providers

*Illinois members: State laws vary with regard to out-of-network benefits. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. endstream endobj startxref 50% of costs until plan has paid $1,750, then any What types of services does the plan cover? WebYour primary care dentist will provide all of your routine dental care and any copayment or discounted charges will be paid at the time of service If you need a specialty dentist, you may receive a 25 percent discount by using one of the participating specialty dentists from Visit the secure website, available through www.aetna.com, for more information. Orthodontia. 0000017206 00000 n 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. Some subtypes have five tiers of coverage. Questions may be directed to Humana provider relations by calling 1-800-626-2741, Monday Friday, 8 a.m. 5 p.m., Central time. The information you will be accessing is provided by another organization or vendor. 0000136750 00000 n endstream endobj startxref You may not have coverage to replace teeth that were lost or extracted before your coverage began. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Sign up at BeneFeds.com or call 1-877-888-3337. See Physician-related/professional services for information regarding vision exams and related services. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Find a dentist near Your plan may have a coordination of benefits provision. This is called an extension of benefits provision. Dental Links to various non-Aetna sites are provided for your convenience only. hb``d``c``e`kgg@ ~'a >/*g3,>Ib1h(ettt4@ ceY You can also view and share your digital ID card from the Aetna Health app. 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. Links to various non-Aetna sites are provided for your convenience only. Go to the American Medical Association Web site. Log in to your member website first to get personalized results. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. hW[O8+~ Any languages spoken in offices indicated in this search are self-reported. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Find the one that's right for you. Hn@})R$R(8I1$o0Z?IT @m$,RRW$_yV? For language services, please call the number on your member ID card and request an operator. Rates | MetLife State of Florida Employees | MetLife hb```, cb.0800(_^Xf5VtUm]81JRtsFGIGcSPaf@Z F y'f??XtO?T)c10 i pg*00Ok D & 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. My Dental PPO - MetLife 0000025338 00000 n In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. %%EOF For previous versions, email us applehealthpharmacypolicy@hca.wa.gov. Signing up is simple and free. You can also contact Member Services to determine if they are eligible under your DMO plan. 0 License to use 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. Preferred Dentist Program - MetLife WebCritical access information for providers MHCP Fee Schedule (MHCP Fee Schedule (dental codes begin on page 55 of the PDF) Fraud, Waste, and Abuse: Combating Medicare Parts C and D Fraud, Waste and Abuse Training Web Based Training Course 2022 Fraud, Waste and Abuse Attestation Fraud, Waste and Abuse Training Log Additional Resources Dental 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. Please see your plan documents. See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page. $10 to $50 to extract a tooth. Hn0R`~(dQQl\0H5oKtFA?v>4.zL >.K;J+p0eLK!YWU-`}\~nxqC79*G: >$LAFMEECJ.&rwBx77C(gOI CHAwl"4Q !b p^y2gp#M In Illinois, DMO plans provide limited out-of-network benefits. You can find a network dentist with our online directory. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. t|%y,$Z1/7`v||f})"h[sE\o~_z~$q-`?X \h-:tm){1U:;%j%D^TN"pX'nw]Fs3)bNiA@g4,pLk,k{s6?}J}A &\R:lf~>W1C",h+QZ{K'.52 zYtVIp`0 x{B&$M"yhZICt`0> :1r 2!iMFnAo)1%i"74/+v[0N)mgaJY[X _1d7$3H\3. Your benefits dont double if you are enrolled in two dental plans. H=o0w7S4oA2dhQ,QITEF}v@DN/8LBl^K]H*f:J]yDyS{dZ>L80|8xa@c7iCSY_yLdZ~2}e$LJV\+8CG09s^@wg8pn@\O9C3b\ O1^7TR6:'o9vS rp:QM{9l-k[[@szQV[*P/0chT}($^X'F-Bw)t]V[atF5]@R,hYxk,7Ge^AF*Ul. Bzb:5Gl8%bYYFMG`L"J/rrkBlF)ltPBVW oz Predeterminations may not be available in all states. Our procedure fee tool provides participants of dental plans insured or administered by MetLife guidance in understanding your dental service providers fees. Applicable FARS/DFARS apply. &,MJtN-F;+U_t+|\b2*M-r!N66;ZWFl\4)*8jw#W`hps>O"9nblas %$puu$|0,}kd4$p$ap,KU{. 6p6@-_2PA p-S:{c:=q|%~nH09ML{Z 'zS'-'&w.&Xu-.@N Benefits provided by SafeGuard Health Plans, Inc., a MetLife company. Enter the street name or intersection instead of address numbers (24th and Broadway instead of 2432 Broadway). Dental 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. It describes the services you have coverage for under your plan. 4792 0 obj <> endobj 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. Yes. Altamonte Springs dentists Boca Raton dentists Clearwater dentists Coral Gables dentists Coral Springs dentists Daytona Beach dentists Delray Beach dentists Englewood dentists Fort Lauderdale dentists Gainesville dentists Grove City dentists The ABA Medical Necessity Guidedoes not constitute medical advice. If this occurs, please refer to the most recent guide. Direct Referral Dental Find individual dental insurance plans near you with budget-friendly coverage options and get a quote. %%EOF Or call Member Services for coverage details. 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 4804 0 obj <>stream \Jc sVB;xN"#~D=1GE SJ4{[HM`|x>~y\YgO_YQ la70'1!!7FY%^P\iRk*#L n~^IJ54g+Rq k (C8y}H7=s2TiUfS^|d yfGBak44\@j WebDental insurance helps you plan for the costs of dental care. DMO plans require a surgical periodontal history. ;^{s4)|I6gPvJ=x 797 0 obj <>/Filter/FlateDecode/ID[<37A34B695481DA4B83FCA71461750ABE><99A26598FF436C418BD6EB0A4885ABA5>]/Index[779 47]/Info 778 0 R/Length 98/Prev 235657/Root 780 0 R/Size 826/Type/XRef/W[1 3 1]>>stream You may still elect to receive services from a non These services include: We may not cover services youve received without coverage. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. QyJh6,j9nsm WL Ogf8jN%7}0Q_%uSiz7XtyLs^14(.x ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. A dentist's reimbursement is a combination of: We have an arrangement with our DMO providers. Aetna Dental 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. This information is neither an offer of coverage nor medical advice. 0000001836 00000 n Your and Your 0000020858 00000 n 0000044288 00000 n For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide. Or contact Member Services for coverage details. 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). HTn0?N$vt.taQ"]QI~}kGvc:PXJ ,DDIuEE}%uDp'QMXzm:h?cZH;%*E[*& MetLife Dental interpreter services at no cost. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. This search will use the five-tier subtype. If you are a participating provider with one or more dental benefit plans, you may want to negotiate with those Illinois DMO is not an HMO. other economic conditions. required under the federal Americans with Disabilities Act of 1990 trailer You must contact us. 0000035971 00000 n However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. Yes, but some plans may limit the benefit to certain teeth. Periodontal maintenance is for patients whove previously had periodontal treatment. 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. For other specialists, a referral may be necessary. When billing, you must use the most appropriate code as of the effective date of the submission. endstream endobj 4793 0 obj <>/Metadata 104 0 R/Names 4814 0 R/Pages 4786 0 R/Perms/Filter<>/PubSec<>>>/Reference[<>/Type/SigRef>>]/SubFilter/adbe.pkcs7.detached/Type/Sig>>>>/StructTreeRoot 113 0 R/Type/Catalog>> endobj 4794 0 obj <>stream Unless required by state law, a pediatric dentist is considered a specialist. 0000050717 00000 n 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 DMO plan doesnt have any deductibles or annual maximums. os yI"f]Ez| y n1|8(AV0jxU&hz=Hw 9\VMwwh!B lsJB&)C|N!!Xr&K{k9i[MU[oKSk&X2EUxkvlM~W 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. HS]O0}_qd_TILXv]@O.K{=p> X1R)MD*u 7p\y D2a\&bh1hq{.uNj`)9T@*pU&T!Bz $2ToWIGtfN.[4y7n1MDP0j=g*E^ X2SYJsOJ=I!J]D]KRihmOS-f&nR#wa{:f$f? Web*** Your dentist says you need a full X-Ray and his usual fee is $175*** What is a participating PDP dentist? metlife dental claim form NCFlex MetLife Triple Options Booklet and FAQs NCFlex MetLife Dental International Travel Assist Flyer MetLife Dental Low Option Certificate 01 01 20 MetLife Dental Low Option Certificate UNC Chapel Hill 01 01 20 MetLife Dental Classic Option Certificate 01 01 20

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