Aetna Dental Insurance Plans for Seniors in 2023 - The Senior List In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. 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. Privacy policy: Aetna.com/legal-notices/privacy.html. 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. Treating providers are solely responsible for medical advice and treatment of members. Provided for your personal comfort or convenience, or the convenience of any other person, including a dental provider. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. Whether youre at your desk or on the go, our easy-to-use digital tools help you manage your dental plan, save money and make smart decisions about your care. The AMA is a third party beneficiary to this Agreement. Applicable FARS/DFARS apply. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Do you cover adult orthodontia? Go to the American Medical Association Web site. Selection of a program provider is also the responsibility of the participant and is not based on any representations by Aetna. Choose a PCD from our network**: Use ourprovider search toolto find one. Aetna Medicare dental plans: Coverage, eligibility, and costs Find the right plans and programs for you. The ABA Medical Necessity Guidedoes not constitute medical advice. PDF Dental Benefits Summary - Aetna Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Learn more and see if your dentist is in the network with these plans on aetna.com. Aetna Invisalign Coverage Your Aetna plan might cover your Invisalign treatment, although it depends entirely on the plan. AetnaDentalOffers.com is brought to you by DentalPlans.com. Overall, it is very affordable compared to competitors and comes with many different amounts of coverage. Acupuncture, acupressure and acupuncture therapy Members must make payments directly to the providers in the Aetna Vital Savings program. 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). *Based on January 2023 Aetna provider data Accessibility Services:If you are a person with a disability who needs assistance using our websites, our Customer Service Representatives can assist you. Want to see options for a different location? For additional language assistance: Choose from more than 120,000 dental providers nationwide, including providers who offer virtual visits through tele-dentistry. Check with your plan for more details. Our plan selection pages will be down for maintenance starting Friday, April 16, at 9 p.m. and returning by 1 p.m. Saturday, April 17. Treating providers are solely responsible for medical advice and treatment of members. 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. See your Evidence of Coverage for details. They also have Direct Preventive, which only covers the costs of preventive dental care. This may be a copay, which is a set dollar amount. When billing, you must use the most appropriate code as of the effective date of the submission. General anesthesia and intravenous sedation, unless specifically covered and only when done in connection with another eligible dental service Claims must be submitted within 365 days of the date you received the service. . PDF A Nationwide Dental PPO Plan - BENEFEDS We're here 8 a.m. - 8 p.m., Monday through Friday. Thats it. It is only a partial, general description of plan or program benefits and does not constitute a contract. First time users can also sign up and register for an account. 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. You will receive the discount off the providers usual and customary fees when you pay. With a PPO plan, you can visit any dentist you want (whether they are in or out of the network) and usually receive some coverage level. 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. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Dental insurance plans are underwritten by Aetna Life Insurance Company. And you don't have to have Aetna medical or other coverage with us to purchase. Some subtypes have five tiers of coverage. Dual Eligible Special Needs Plans (D-SNP). PDF Summary of Dental Benefits and Coverage Disclosure Matrix (SDBC) Part I 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. You may pay more when you get care from dentists who arent in the network.**. Please consult with the respective plan detail page for additional plan terms. To view the form just select Continue. You have the freedom to care for your smile your way with this PPO plan. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. You should: Review the Electronic Claim Vendor List Electronic Claim Vendor List. 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 2022 - 2023 Aetna PPO Dental Plan Design and Benefits Summary Visit any licensed dentist - in or out of network In network: Visit a dentist in the Aetna Dental PPO* network. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. Please log in to your secure account to get what you need. Use order code 123AET200. Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. 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. Provided by an out-of-network provider in excess of the recognized charge. The material is for information only. 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. With Aetna Dental Direct, you'll get the coverage you need to keep your teeth healthy. ZIP CODE View 2023 plans Learn about these benefits Dental, eyewear and hearing coverage is available. This benefit maximum can range from about $150 to $6,000. Get discounts on oral health care products like Z Sonic toothbrushes, replacement brush heads and various oral health care kits. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. Visit the secure website, available through www.aetna.com, for more information. All Rights Reserved. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. 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. Message and data rates may apply.***. Some subtypes have five tiers of coverage. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). That are experimental or investigational. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. We've broken down the differences between our DMO dental benefits and insurance plan and our PPO dental insurance plans to help you decide. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. You may also be required to pay a portion of the costs. Language services can be provided by calling the number on your member ID card. 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. Aetna Dental PPO plan for Federal employees - Aetna Feds Dental Preferred Provider Organization (DPPO) Plans | Cigna 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. Taking care of your teeth is as an important part of taking care of your health. Aetna Dental Insurance Review: One Of The Best In 2023 - Seniors Mutual You get a broad choice of dentists and dental providers, wellness discounts and offers that stretch your health care dollar, digital tools to easily manage your care, and more. your coverage will begin on January 1, 2022. Not available in many states. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Aetna Dental provides national network coverage for Prince George's County Government through two networks: You receive greater benefit coverage when you use a provider who participates in the Aetna Dental participating network. Links to various non-Aetna sites are provided for your convenience only. See the insurance policy for details. There also may be age and frequency limits on some services. Links to various non-Aetna sites are provided for your convenience only. 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). All services deemed "never effective" are excluded from coverage. Aetna Inc. and itsitsaffiliated 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. Coinsurance: the percentage of dental care expenses you pay after your deductible. Youll need to select a primary care dentist in the DMO network. Network dentists also file claims for you. If youre submitting your form online, be sure to attach your receipt to your submission. Aetna dental insurance for seniors offers three different plans to choose from. - It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. With adirect member reimbursementallowance, youre givena set amount of money to spend each year on dental care.. Visit any licensed dentist outside the network. Dental benefits are already included inthe majority ofAetna MA plans. 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). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. Treating providers are solely responsible for dental advice and treatment of members. 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 Member Log-in That would not be made if you did not have coverage. Please log in to your secure account to get what you need. 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). Register A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and . Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Cancelled or missed appointment charges or charges to complete claim forms. Treating providers are solely responsible for dental advice and treatment of members. For work that began before you were covered under the plan, The following dental services and supplies. It gives members access to discounted fees according to schedules negotiated with providers by Aetna Life Insurance Company for Aetna Vital Savings. Deductible and annual maximum amounts cross-apply between in network and out of network. With Aetna Dental Direct, youll get the coverage you need to keep your teeth healthy. ${tty} to chat about any Medicare questions you have. Coverage Period: 01/01/2022 - 12/31/2022 Coverage for: Self Only, Self Plus One or Self and Family | Plan Type: PPO The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. In Pennsylvania, the waiting period is called an elimination period and most Basic services have one month waiting period. Enrollment in our plans depends on contract renewal. 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. - The tooth is an abutment to a covered partial denture or fixed bridge. What's an Evidence of Coverage (EOC)? | Aetna Medicare 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. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services.
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