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. Aetna Dental Direct | Secure Member Portal Login Secure Member Portal * required Username * Forgot Username? ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Treating providers are solely responsible for medical advice and treatment of members. You may also have to file your own claims. Caring for your teeth should never feel out of reach with Aetna Dental Direct. 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. 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. Once youre a member, you have two ways to engage with your plan online. Aetna Invisalign Coverage Your Aetna plan might cover your Invisalign treatment, although it depends entirely on the plan. 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. Treating providers are solely responsible for medical advice and treatment of members. 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. Provided for your personal comfort or convenience, or the convenience of any other person, including a dental provider. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Check any insurance plan benefits you have before using these discount offers, as those benefits may give you lower costs than these discounts. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Yes, I'm a memberNo, I'm looking for a plan. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. If you do not intend to leave the Medicare site, close this message. The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. The information you will be accessing is provided by another organization or vendor. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". Direct member reimbursement allowance: How to get reimbursed for dental care. Visit any licensed dentist outside the network. LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Dental services and supplies made with high noble metals (gold or titanium) except as covered in the Eligible Dental Services section of your insurance policy are covered at 100% on most plans. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. - The tooth is an abutment to a covered partial denture or fixed bridge. You are now being directed to CVS Caremark site. With Aetna Vital Savings, you can choose from more than 250,0001 available dental practices across the country. Everyone can get their own in-network primary care dentist. Due to therelatively high out-of-pocket costs for these procedures, some older adultsend up forgoing necessary dental care. * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). 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. CPT is a registered trademark of the American Medical Association. 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 Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Does your dental plan have a missing tooth clause? 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. Aetna Dental has over 50 years of experience offering dental benefits. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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. Premium deductions will start with the first full pay period Aetna does not endorse any vendors, products or services associated with this program. Some plans will cover around 50% of adult orthodontic treatment (including Invisalign), while others will only cover children up to 19 years old. Surgical removal of impacted wisdom teeth when only for orthodontic reasons You can also submit paper claims. In excess of the benefit, dollar, day, visit, or supply limits stated in your schedule of benefits. Disclaimer of Warranties and Liabilities. This means you pay nothing out of pocket if you stay in network. When billing, you must use the most appropriate code as of the effective date of the submission. Rates start at $7.99 a month. Provided by an out-of-network provider in excess of the recognized charge. The member's benefit plan determines coverage. 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. If youre unable to print out the form, you can write out all the required information on a piece of paper and send it with your receipts. Check with your plan for more details. You can change your PCD once a month on your member website. That are experimental or investigational. Or log in to your member account to submit the form online. 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). Replacement of teeth beyond the normal complement of 32 Applicable FARS/DFARS apply. 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 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. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. CPT only Copyright 2022 American Medical Association. 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 Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. *** Terms and conditions: Bit.ly/2nlJFYG. Acupuncture, acupressure and acupuncture therapy This benefit provides coverage of preventive and comprehensive dental services up to a benefit maximum and allows the member to choose any licensed dentist, in or out of network. Coverage for the first installation of removable dentures; fixed bridgework and other prosthetic services is subject to the requirements that such removable dentures, fixed bridgework and other prosthetic services are: needed to replace one or more natural teeth that were removed while this policy was in force for the covered person; and are not abutments to a partial denture; removable bridge; or fixed bridge installed during the prior 8 years. Aetna Vital Savings provides participants with access to a network of independent practicing providers. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. There are no claims or referrals to worry about, and no limits on how much you can save. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. your primary care dentist will refer you to one in our network. CPT only copyright 2015 American Medical Association. A Nationwide Dental PPO Plan Who may enroll in this plan: All Federal employees, annuitants, and . You may pay more when you get care from dentists who arent in the network.**. CPT is a registered trademark of the American Medical Association. This information is neither an offer of coverage nor medical advice. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Youll need to select a primary care dentist in the DMO network. Enrollment in our plans depends on contract renewal. 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. Applicable FARS/DFARS apply. You are now being directed to CVS Caremark site. Aetna Life Insurance Company, 151 Farmington Avenue, Hartford, CT 06156, 1-877-698-4825, is the Discount Medical Plan Organization. How to enroll: Member Services: 1-877-238-6200 Unlisted, unspecified and nonspecific codes should be avoided. Get lower rates when you go to a dentist thats in your PPO network. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 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. Do you want to continue? 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. So, your share of the cost is usually lower. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. 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. A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl. Includes PPO, HMO, HMO-POS medical plans with or without drugs. We encourage you to check with your participating provider prior to beginning treatment. Choose from leading manufacturers and get free follow-up service for one year. Brushing, flossing and getting regular dental checkups help to keep your mouth healthy. Applicable FARS/DFARS apply. 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. 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. 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. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. Aetna MA plans offer three types of dental coverage: For HMO plans, you must see a dental care provider within the network of approved providers. Aetna handles premium payments through Payer Express, a trusted payment service. Dental PPO insurance plans are underwritten and/or administered by Aetna Life Insurance Company (Aetna). Go to the American Medical Association Web site. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. This Agreement will terminate upon notice if you violate its terms. Dental insurance plans are underwritten by Aetna Life Insurance Company. The change will start the first day of the next month. Purchasing the Aetna dental discount cards is easy - online, by mail or by phone. Pay less for acupuncture,* chiropractic visits, therapeutic massage and nutrition services** and for products like wearable fitness devices and fitness kits. California license number: OB84599. Note not all Aetna dental plans and offers available in all markets. Aetna will continue to offer most Medicare Advantage members access to routine vision, dental and hearing coverage. 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. 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. With adirect member reimbursementallowance, youre givena set amount of money to spend each year on dental care.. Why choose ${company} Medicare Solutions? LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 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. 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. This material is for information only. Your dental plan may have yearly and lifetime limits on coverage. 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. . Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". All Rights Reserved. 1According to the Aetna Enterprise Provider Database as of May 1, 2018. Please log in to your secure account to get what you need. Aetna Medicare SM Plan (PPO) Learn more about Aetna Feeling Good: Your Verizon Aetna magazine Check out Feeling good , the magazine created specifically for Verizon Aetna members. Others have four tiers, three tiers or two tiers. Or it may be coinsurance, which is a percentage of the dentists charge. Your benefits plan determines coverage. If you have questions about your Medicare plan, start here. 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 Very low rates. You have the freedom to care for your smile your way with this PPO plan. Teeth whitening and facings on molar crowns and pontics will always be considered cosmetic. That are provided by a family member. 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. 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. Not available in many states. 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. As you plan for your dental care, keep in mind that you may have limits on the amount of preventive care visits you can make each year, as well as caps on coverage for comprehensive services. New and revised codes are added to the CPBs as they are updated. 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. This Aetna Dental Preferred Provider Organization (PPO) benefits summary is provided by Aetna Life Insurance Company for some of the more frequently performed dental procedures. 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. The AMA is a third party beneficiary to this Agreement. Links to various non-Aetna sites are provided for your convenience only. Special promotions including, but not limited to, additional months free are not available to California residents or on Fully Insured Plans. But your plan features and costs will vary depending on the plan you choose. 2022 Aetna Dental 2 Enroll at www.BENEFEDS.com . *Based on January 2023 Aetna provider data In case of a conflict between your plan documents and this information, the plan documents will govern. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. The availability of a particular provider cannot be guaranteed and provider network composition is subject to change. It is only a partial, general description of plan or program benefits and does not constitute a contract. Just check with your employer to see which plans are available to you. Pros. Just show your discount card at your appointment and you'll get instant savings 15 percent to 50 percent off the cost of most services*. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. Program providers are solely responsible for the products and services they provide. 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. Network dentists also file claims for you. If you do not intend to leave our site, close this message. Check your benefits summary, so youll know what to pay. Aetna Dental PPO Plan More reasons to smile Worldwide dental coverage and plans with no deductible New Hires have 60 days to choose benefits. 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. Use order code 123AET200. It does not meet the Minimum Creditable Coverage requirements in Massachusetts. Most of our HMO-POS plans require you to use a network provider for medical care but provide you with flexibility to go to licensed dentists in or out of network for routine dental care. The ABA Medical Necessity Guidedoes not constitute medical advice. All services deemed "never effective" are excluded from coverage. You may be balance billed by out-of-network dentists up to the dentists standard fee. 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. Aetna does not provide dental, medical, vision or other health care/treatment. That would not be made if you did not have coverage. 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. 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. However, if you do this, you wont benefit from negotiated rates. Reprinted with permission. See the insurance policy for details. 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. Instead, check your benefits summary to find your share of the costs. 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. 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. You also have the flexibility to visit a licensed dentist who does not participate in our network. 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. Check your Evidence of Coverage (EOC) for more details. Compare our plans and find the coverage that's best for you. 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. Dental implants, false teeth, prosthetic restoration of dental implants, plates, dentures, braces, mouth guards, and other devices to protect, replace or reposition teeth and removal of implants Get the Aetna Health app by texting GETAPP to 90156 for a link to download the app and create an account. For additional language assistance: Espaol | | Ting Vit | | Tagalog | P | | Kreyl | Franais | Polski | Portugus | Italiano | Deutsch | | | Other Languages. - It is treatment for decay or traumatic injury and teeth cannot be restored with a filling material Information is believed to be accurate as of the production date; however, it is subject to change. Learn more about our network and DMR plans Search other providers Need a provider directory? Aetna dental insurance for seniors offers three different plans to choose from. All Aetna Dental plans offer a wide choice of dentists, wellness discounts and convenient digital tools. Disclaimer of Warranties and Liabilities. Certain preventive care services are covered at little-to-no-extra cost 2 when . It gives members access to discounted fees according to schedules negotiated with providers by Aetna Life Insurance Company for Aetna Vital Savings. The dental discounts are available through participating healthcare providers only. Aetna handles premium payments throughInstaMed, a trusted payment service. 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. A primary care dentist (PCD) helps guide your care with this DMO* plan. 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. The amount of the discounts will vary depending on the provider and type of service or supply received. 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. 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. By submitting your information you are agreeing to receive communications from Aetna Dental Offers. Apple and the Apple logo are trademarks of Apple Inc., registered in the U.S. and other countries. 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). While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. CPT only Copyright 2022 American Medical Association. Please consult with the respective plan detail page for additional plan terms. In Pennsylvania, the waiting period is called an elimination period and most Basic services have one month waiting period. Treating providers are solely responsible for dental advice and treatment of members. Sachi Fujimoriis a writer and editor based in Brooklyn who focuses on writing about science and health. Reprinted with permission. There also may be age and frequency limits on some services. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Under the Dental Preferred Provider Organization (PPO) plan, you may choose at the time of service either a PPO participating dentist or any nonparticipating dentist. Others have four tiers, three tiers or two tiers. That are cosmetic in nature. 151 Farmington Avenue, Hartford, CT 06156. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). You can start using your plan right away! For someAetna MA plansthatdontincludedental coverage, you mayhave the choiceof payingextra each month for dental benefits. Members should discuss any matters related to their coverage or condition with their treating provider. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. For work-related conditions. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. 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). These dental benefits follow the same structure as network plans and may require you to choose a dental provider within your network. Your InstaMed log in may be different from your Caremark.com secure member site log in. 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. Dental benefits and dental insurance plans contain exclusions and limitations.
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