Please log in to your secure account to get what you need. access to covered services, including insureds with disabilities as To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with in-network providers. Unless required by state law, a pediatric dentist is considered a specialist. Metropolitan Life Insurance Company, New York, NY 10166 Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. Dental 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 To find out, just call Member Services. Federal Dental Insurance | MetLife FEDVIP 2023 Provider Quick Reference Guide Search for a dentist by name, specialty, ZIP code or the number of miles you are willing to travel. \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 Signing up is simple and free. City of Virginia Beach and Virginia Beach City Public Schools For telehealth policies and FAQs, see Telehealth on this page. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. 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 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). 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. Aetna Dental They do so as if there is no secondary payor. other economic conditions. endstream endobj 780 0 obj <>/Metadata 30 0 R/Pages 777 0 R/StructTreeRoot 55 0 R/Type/Catalog/ViewerPreferences 798 0 R>> endobj 781 0 obj <>/MediaBox[0 0 612 792]/Parent 777 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 782 0 obj <>stream MetLife Preferred Dentist Program (PDP) Overview Commonly 0qPWp:dW5 ;6V]BpJ#@DE"?Fo=+57]>>=@^{"p5yM~'A}t`)6ts(T^ `p]~@5zPn/VO=RB;#Gkj@!bg~7s}f Discover the best option: HMO, PPO and TakeAlong Dental Ho0?4$#UVCr!bf! B[@U=7Y>6.vf Direct Referral Dental Plan* MET185A. In case of a conflict between your plan documents and this information, the plan documents will govern. Metlife - Member Dental Plan Benefits - Member Benefits Dental RNa: Log in to your member website first to get personalized results. cy The ADA anticipates that the costs of providing care will substantially increase for many dental procedures. This SCHEDULE OF BENEFITS lists the Covered Services available to You and Your Dependents under Your dental plan, as well as Your and Your Dependents costs for each Covered Service. Altamonte Springs dentists Boca Raton dentists Clearwater dentists Coral Gables dentists Coral Springs dentists Daytona Beach dentists Delray Beach dentists Englewood dentists Fort Lauderdale dentists Gainesville dentists Grove City dentists The member's benefit plan determines coverage. MetLifes Preferred Provider Organization (PPO) plans feature the MetLife Preferred Dentist Program, which is designed to save you money on dental services.1 You can choose from thousands of participating general dentists and specialists nationwide. You are now being directed to CVS Caremark site. Provider billing guides and fee schedules - Washington Click home to navigate to home.. Click reset to reset the application.reset to reset the application. This search will use the five-tier subtype. If you need interpretation services and are enrolled in the Preferred Dentist Program (Dental hbba`b``30 Ga endstream endobj 4797 0 obj <>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 4798 0 obj <>stream Click home to navigate to home.. Click reset to reset the application.reset to reset the application. When your st dentisuggests treatment, have him or her send a claim form, along with the proposed mtreneatt plans and supporting documentation to MetLife. Fee Schedule t|%y,$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. You may choose a new one once a month. Who can enroll in the plan? HOO1sj^ !CHTww`]%6x7A|!! 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. If you had coverage under a previous insurance carrier, youll have coverage for certain services by that plan even after your Aetna coverage begins. 4+t?1zxn nmZn5&xUAX5N(;a,r}=YUUA?z r[ $ HtTYo@~0IOHC We encourage you to select a primary dentist at the time of enrollment. CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians. 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). Ooops!!! - MetLife WebYou may choose one of four dental plans, offered by SafeGuard, a MetLife Company and Metropolitan Life. Since Clinical Policy Bulletins (CPBs) 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. Select "Search" to go to the Find a Dentist tool, choose your network and enter your ZIP code for a list of participating dentists. The MetLife dental network includes thousands of providers, so finding the right dentist is easy. Our plans give you the flexibility to visit providers in or out-of-network. 3 Most cleanings and exams are covered 100%. CPT is a registered trademark of the American Medical Association. Links to various non-Aetna sites are provided for your convenience only. 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. (For example, if you change your PCD on April 15, the change will take effect May 1. Contact Member Services if you have questions. When billing, you must use the most appropriate code as of the effective date of the submission. The primary payor pays claims as it normally does. By contacting the Payor, a provider can identify which network fee schedule is being utilized for claim reimbursement and verify participation status with the plan. HW$WtM7GmFx4;c}""ztl3*_}"_^_Vkj*[iBK+i?n~/_-la6l{^}m>lq><9n?[{*w^G{e7+Q1V\tm8Vxp7%^t9u(28~Z6v{uf{T% 59Wv_[\}#=a.E1hqYM"8dT1!`9~]hGuDKGgyQ\knr[{tEr:Ad^KbP\9RuCn,sSvjkP(G#OJt3ooQc 1(*@v You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Information is believed to be accurate as of the production date; however, it is subject to change. Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna). 0000136750 00000 n In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. &,MJtN-F;+U_t+|\b2*M-r!N66;ZWFl\4)*8jw#W`hps>O"9nblas %$puu$|0,}kd4$p$ap,KU{. 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. 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. Reprinted with permission. Or call Member Services at the number on your ID card. 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. If so, the primary care doctor will arrange it. 163 0 obj <> endobj You may not have coverage to replace teeth that were lost or extracted before your coverage began. They will be able to verify your coverage. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. You must contact us. Or contact Member Services for coverage details. WebPlease note all requested contact information is for the provider * Due to contractual requirements, MetLife is prevented from soliciting certain providers. 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. Dental insurance 0000001836 00000 n For language services, please call the number on your member ID card and request an operator. Check your Aetna Summary of Benefits. After you complete a service, you file claims through the ProviderOne portal. The DMO plan doesnt have any deductibles or annual maximums. Some services have this type of restriction. WebDenteMax is one of the largest leasable dental PPO networks in the United States. endstream endobj 4796 0 obj <>stream The $150 co-payment is for a plain metal crown. QyJh6,j9nsm WL Ogf8jN%7}0Q_%uSiz7XtyLs^14(.x Dental <<5AE96FDB43CC14498BFAFB7B8207E05A>]/Prev 310465/XRefStm 1499>> "CYhpEObbG`aH??iQSj*{rfLbEdv va[?UZ.Nna!gI\ ,X]5 Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 2023 MetLife Services and Solutions, LLC Why? endstream endobj startxref Applicable FARS/DFARS apply. 0000016556 00000 n 0000001199 00000 n Find a dentist near 0000044706 00000 n WebDental insurance helps you plan for the costs of dental care. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 0000044035 00000 n Dental Each covered family member can select their own. Links to various non-Aetna sites are provided for your convenience only. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept". 0000036990 00000 n Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. You or your dentist may also call Member Services. 50% of costs until plan has paid $1,750, then any Network dentists are paid contracted fees. Your benefits dont double if you are enrolled in two dental plans. Hn@})R$R(8I1$o0Z?IT @m$,RRW$_yV? 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. WebYikes, something went terribly wrong!!! Provider Forms and Downloads Our clients of insurance companies, third-party administrators and various groups lease the DenteMax PPO network for use in their dental benefit plans in order to service their more than 20 million members nationwide. endstream endobj 4795 0 obj <>stream The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. WebJust select a participating dentist at enrollmentthen refer to your Schedule of Benefits to see what's covered and your costs. Questions may be directed to Humana provider relations by calling 1-800-626-2741, Monday Friday, 8 a.m. 5 p.m., Central time. However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. This will let you and the dentist know what the benefit will be if the service is done. Fee Lookup 0000025338 00000 n H|y\GozfKQgxDxk5Q"E[/P# GYf>WWU]z #Fv;t|*DDG&)07"jnlM&r3fLIsg@L?2t&&:r@p>_hwxwm!1IcNp,<6nfT^IAI. general dentist or specialist who meets MetLifes strict credentialing For other specialists, a referral may be necessary. Illinois DMO is not an HMO. You can also contact Member Services to determine if they are eligible under your DMO plan. Include North/South/East/West with address if appropriate. trailer They arent a PCD. Some problems may need more than one service to fix. The ABA Medical Necessity Guidedoes not constitute medical advice. All Rights Reserved. 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 0000039476 00000 n endstream endobj 4802 0 obj <>stream 20% PPO and out-of-state; 30% non-PPO. RLaVHQB-JS=*ccYqE,cD98q:A-H}D+&\jC80n 3"Dtd(DDhy +pE8ai:H,[9"XX$'8ZD` t'+"1:wu0.Zg*e ^Eya}uqUUF)j^c[d8unIq:J_|u[#,gNj[bS }|2"X$^=O\.agtV|1`G~eY)ez_!+!:v*J Q(v~RppZpccCSZgc3p7~{1^zVEQ5+c1 ;{ycu$g@y&A|d(:6e FkG=^:s`P$aq/lX}N970/k All agency-contracted managed care organizations (MCOs) and the fee-for-service (FFS) program use the Apple Health PDL. (Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide. If you need more information, contact Member Services. %%EOF 2023 to February 25, 2023 Telemedicine billing guide, November 2, 2022 to December 31, 2022 Telemedicine billing guide, August 1, 2022 to present Apple Health (Medicaid) physical health audio-only procedure codes, January 1, 2023 to present - Apple Health (Medicaid) audio-only behavioral health codes, August 1, 2022 to December 31, 2022 Apple Health (Medicaid) audio-only behavioral health codes, June 28, 2022 to July 31, 2022 Telehealth services billing guide audio only supplement, May 12, 2023 to present - Clinical policyfor COVID-19, August 1, 2022 to May 11, 2023 Apple Health (Medicaid) clinical policy and billing for COVID-19, July 22, 2022 to July 31, 2022 Apple Health (Medicaid) clinical policy and billing, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) clinical policy and billing, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) clinical policy and billing, View all clinical policy and billing FAQs, June 6, 2020 to December 31, 2021 Apple Health (Medicaid) telemedicine/telehealth brief, May 10, 2020 to June 6, 2020 Apple Health (Medicaid) telemedicine/telehealth brief, April 29, 2020 to May 9, 2020 Apple Health (Medicaid) telemedicine/telehealth brief, May 12, 2023 to present - Apple Health (Medicaid) behavioral health policy and billing, August 1, 2022 to May 11, 2023 Apple Health (Medicaid) behavioral health policy and billing, February 1, 2022 to July 31, 2022 Apple Health (Medicaid) behavioral health policy and billing, April 29, 2021 to January 31, 2022 Apple Health (Medicaid) behavioral health policy and billing, View all behavioral health policy and billing FAQs, July 22, 2022 to present Apple Health (Medicaid) ABA policy and billing, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) ABA policy and billing, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) ABA policy and billing, July 22, 2022 to present Apple Health (Medicaid) FAQ for diabetes education providers, February 1, 2022 to July 21, 2022 Apple Health (Medicaid) FAQ for diabetes education providers, January 1, 2022 to January 31, 2022 Apple Health (Medicaid) FAQ for diabetes education providers, View all FAQs for diabetes education providers, May 3, 2020 to present Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, November 20, 2020 to May 2, 2021 Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, October 1, 2020 to November 19, 2020 Apple Health (Medicaid) home health services billing and policy during COVID-19 pandemic, View all home health services billing and policy FAQs, July 22, 2022 to present Telehealth requirements for physical, occupational and speech therapy, February 1, 2022 to July 21, 2022 Telehealth requirements for physical, occupational and speech therapy, January 1, 2022 to January 31, 2022 Telehealth requirements for physical, occupational and speech therapy, View all telehealth requirements for physical, occupational, and speech therapy, January 1, 2022 to present Telehealth services in long term care facilities and skilled nursing facilities, May 3, 2021 to December 31, 2021 Telehealth services in long term care facilities and skilled nursing facilities, October 1, 2020 to May 2, 2021 Telehealth services in long term care facilities and skilled nursing facilities, View all Telehealth requirements for LTC and SNF, February 1, 2022 to present Family planning only billing guide telemedicine/telehealth, January 1, 2022 to January 31, 2022 Family planning only billing guide telemedicine/telehealth, May 3, 2021 to December 31, 2021 Family planning only billing guide telemedicine/telehealth, April 1, 2023 to present TransHealth program billing guide, January 1, 2023 to March 31, 2023 TransHealth program billing guide, January 1, 2023 to present TransHealth fee schedule, April 1, 2023 to present Tribal health billing guide, January 1, 2023 to March 31, 2023 Tribal health billing guide, October 1, 2022 to December 31, 2022 Tribal health billing guide, View all Tribal Health Program billing guides, January 1, 2023 to present Tribal health program fee schedule, January 1, 2022 to December 31, 2022 Tribal health program fee schedule, October 1, 2021 to December 31, 2021 Tribal health program fee schedule, July 1, 2022 to present Vision hardware billing guide, January 21, 2022 to June 30, 2022 Vision hardware billing guide, January 1, 2022 to January 20, 2022 Vision hardware billing guide, Guidance for hospitals in billing MCOs for services provided to newborns, January 1, 2023 to present Refer to the. WebYikes, something went terribly wrong!!! MetLife Dental Comparison Chart Select one of the SafeGuard DHMO Plans or one of the MetLife Enter the street name or intersection instead of address numbers (24th and Broadway instead of 2432 Broadway). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. The information you will be accessing is provided by another organization or vendor. All Rights Reserved. Payments Information WebWhen is periodontal maintenance covered? 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. How are claims The member's benefit plan determines coverage. These services include: We may not cover services youve received without coverage. 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. Periodontal maintenance is for patients whove previously had periodontal treatment. 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 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). HMo0?v:JzXc/Y~ 4$8#27t9hkG~NMf]n+tAk Wh._AkJ~Mm1.O]f.ixk% (ABT iE%Jz,3X6#N]W_Q.v(>2(0CH*vy!f( WebCan I get an estimate of my out-of-pocket expenses? Dental HMO/Managed Care Plans | MetLife If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Find a Vision Provider - mymetlifevision.com Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. There are several types of coordination of benefits provisions. As a MetLife Vision customer you can access language 0000001677 00000 n New and revised codes are added to the CPBs as they are updated. 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 $500 or greater. WebMetLife's Preferred Dentist Program allows you to select from a network of dentists who have agreed to charge discounted fees. CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Dental 0000035839 00000 n You can find a network dentist with our online directory. O . rxo @ e(m#GIByY6Cs|@5'C/9GL[sN`8!@d2j It sets what they can charge for covered services. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. HQK0+.y+B")RaO m!n[d]{1|9s}Z2t6BIe)U$}C`u! Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis. For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide. 0000050787 00000 n WebFind a Dentist. Use the ProviderOne portal to see if a client is eligible for the service and the billing guides and fee schedules to determine if a PA is required. Search our network GEHA's 2023 Dental Benefits Need help choosing a plan? WebMetLife has the largest range of dental insurance plans and providers among dental insurance organizations. 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. MetLife Dental Oral surgery You pay 20% of covered services for basic surgery; 50% of covered major surgery. Find a Dentist - providers.online.metlife.com 0000050892 00000 n Copyright 2015 by the American Society of Addiction Medicine. 0000113149 00000 n Register and log in to your member website. ", The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. 0000037929 00000 n WebAmount of every $100 in premiums used to pay for claims and administration for the year ending Dec. 31, 2017 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. The Apple Health PDL can be found on the agency's Apple Health PDL page. Each main plan type has more than one subtype. The following monthly costs are effective 1/1/2022 12/31/2022 MetLife Dental 0000035971 00000 n 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.
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metlife dental fee schedule 2020 for providers