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. 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 Vital Savings provides participants with access to a network of independent practicing providers. Preventive services (cleaning, x-rays, exams, etc.) Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Message and data rates may apply.***. With Medicare Advantage plans that include a network dental benefit, youre covered up front for specified dental services but may be required to see a dentist within your network of providers. That are experimental or investigational. Note not all plans and offers available in all markets. You pay up front for dental care and submit receipts for reimbursement. 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 . 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. 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. Choose a PCD from our network**: Use ourprovider search toolto find one. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. 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. No claims or paperwork for in-network care. 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. 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. 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. Deductible applies to basic and major services only. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. The SBC shows you how you and the plan would share the cost for covered health care services. * In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). Aetna Dental Direct insurance plan is offered by Aetna Life Insurance Company (Aetna). The school has chosen a plan that makes it easy to keep your smile. Members should discuss any matters related to their coverage or condition with their treating provider. 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. Aetna Medicare Advantage HMO-POS plans. 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. 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. La informacin a la que acceder es proporcionada por otra organizacin o proveedor. When billing, you must use the most appropriate code as of the effective date of the submission. 4. . 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. Massachusetts license number: 10041444. You are now being directed to the CVS Health site. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Pros. Preventive services Waiting period*: None, Basic services are covered at 80% with in-network providers (after deductible), Major services are covered at 50% with in-network providers (after deductible), Waiting periods for basic and major care waived with prior dental insurance, No waiting periods for preventive services, See any dentist, but youll save more if you stay in network, 100% coverage for preventive services when you see an in-network dentist, Basic services covered at 80% with in-network providers (after deductible), Major services covered at 50% with in-network providers (after deductible), Waiting periods* for Basic and Major services waived with prior dental insurance, $50 individual / $150 family per calendar year, Waiting period is waived if all family members enrolling had dental coverage within the past 90 days. Links to various non-Aetna sites are provided for your convenience only. Aetna dental insurance comes with stand-alone dental coverage or dental, vision, and hearing coverage. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. All services deemed "never effective" are excluded from coverage. the difference in cost between the approved less costly service and the more costly covered service. Check with your plan for more details. 1999- 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. You may also have to file your own claims. 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. Aetna handles premium payments through InstaMed, a trusted payment service. Youre given an annual allowance to spend on dental care. 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. The information you will be accessing is provided by another organization or vendor. All Rights Reserved. Aetna Student Health is offering a Dental Preferred Provider Organization (PPO) planto Columbia University students and their eligible dependents. DISCOUNT OFFERS ARE NOT INSURANCE. So, you wont see cost information here. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. Aetna Dental Direct PPO Plans are Subject to the Following Rules: Replacement Rule While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. As you age, maintaining your oral health is an important part of your whole-body wellness. 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 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. If you do not intend to leave Aetna Medicare, close this message. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services. 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. If you have questions about your Medicare plan, start here. The member's benefit plan determines coverage. Covered family members can choose their own PCDs. 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). Links to various non-Aetna sites are provided for your convenience only. Taking care of your teeth is as an important part of taking care of your health. Please consult with the respective plan detail page for additional plan terms. Important Disclaimers for Medicare Members For questions on your dental benefits, call us 1-866-409-0937 (TTY: 711). Aetna Health members, log-in securely to your account to access all of your health and benefits information, or get your user name and/or password if you've forgotten it. For work that began before you were covered under the plan, The following dental services and supplies. Understand the link between infections in the mouth, and their impact on other parts of the body. The information you will be accessing is provided by another organization or vendor. 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. It does not meet the Minimum Creditable Coverage requirements in Massachusetts. 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. 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. Claim FAQ. And you dont have to have Aetna medical or other coverage with us to purchase. This benefit maximum can range from about $150 to $6,000. 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. Very low rates. Medicare coverage for the whole you body, mind and spirit, Discover coverage that takes a total approach to health, See how we help you get the right resources and care, Take full advantage of everything your plan offers you. your coverage will begin on January 1, 2022. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. 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. This is the total amount per person your plan will pay toward the in-network cost of dental care each year. 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. If your plan doesnt include dental coverage, or you want to increase your coverage, you may have the option to purchase dental benefits with an additional monthly premium (coverage varies by plan). For additional language assistance: Choose from more than 120,000 dental providers nationwide, including providers who offer virtual visits through tele-dentistry. Get discounts on oral health care products like Z Sonic toothbrushes, replacement brush heads and various oral health care kits. Aetna Dental has over 50 years of experience offering dental benefits. Persons with a hearing or speech disability can use 711 for Telecommunications Relay Service (TRS). If you do not intend to leave our site, close this message. The amount of the discounts will vary depending on the provider and type of service or supply received. If you do not intend to leave our site, close this message. Allow approximately 4-6 weeks for reimbursement. Sign up at BeneFeds.com or call 1-877-888-3337. Get the Aetna Health app by texting GETAPP to 90156 for a link to download the app and create an account. While we encourage you to submit all claims electronically, if you need to submit a paper claim, Review our paper claim Tips. 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. 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. 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. 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. 151 Farmington Avenue, Hartford, CT 06156. No deductible, no claims forms and no yearly dollar limits. 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 Aetna Vital Savings discount program is not insurance. This material is for information only. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Youll pay for your dental care up front when you see a dentist, and then submit your receipts to Aetna for reimbursement. Most plans also have a benefit maximum, a limit on the amount the plan will pay out to cover dental services. 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. 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 New and revised codes are added to the CPBs as they are updated. Want to see options for a different location? The member's benefit plan determines coverage. Disclaimers. But your plan features and costs will vary depending on the plan you choose. You may pay more when you get care from dentists who arent in the network.**. Aetna does not endorse any vendors, products or services associated with this program. You also have the flexibility to visit a licensed dentist who does not participate in our network. 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). Get the coverage you need to keep your mouth, teeth and gums healthy. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. Knowing more about your plan can help you get the most from your benefits and covered services. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. 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. Enjoy discounts on hearing aids, exams and hearing aid batteries mailed to your home. Treating providers are solely responsible for medical advice and treatment of members. The maximum deductible for 2022 is $480, but this plan (Aetna Medicare Choice Plan (PPO)) has a $200. Dual Eligible Special Needs Plans (D-SNP). 2023 DentalPlans.com, Inc. All Rights Reserved. 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. 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. There is one exception, however:If you needmedicaldental procedures whileyourein the hospital, Medicare may pay for those services as part of Medicare Part A (hospital insurance). 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. Dental information programs provide general dental information and are not a substitute for diagnosis or treatment by a dentist or other health care professional. Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN). 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). Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Participating dentists have agreed to provide services at a negotiated rate for covered services. All Rights Reserved. Each main plan type has more than one subtype. Services and supplies provided where there is no evidence of pathology, dysfunction or disease, other than covered preventive services Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Compare our plans and find the coverage that's best for you. The program does not make any payments to providers. Click here to review plans with a $0 deductible. That would not be made if you did not have coverage. The following information is about the Aetna Medicare Choice Plan (PPO) formulary (or drug list). Others have four tiers, three tiers or two tiers. 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). Links to various non-Aetna sites are provided for your convenience only. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Surgical removal of impacted wisdom teeth when only for orthodontic reasons 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. 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. With Aetna Dental Direct, youll get the coverage you need to keep your teeth healthy. The plan offers preventive treatment at 100% with no out of pocket cost. Get coverage to any doctor (in or out-of-network) at the same member cost share. By texting 90156, you consent to receive a one-time marketing automated text message from Aetna with a link to download the Aetna Health app.
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