Click home to navigate to home.. Click reset to reset the application.reset to reset the application. 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. Sign up at BeneFeds.com or call 1-877-888-3337. MetLife Dental Comparison Chart The DMO plan doesnt have any deductibles or annual maximums. CPT is a registered trademark of the American Medical Association. WebDental insurance helps you plan for the costs of dental care. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. os yI"f]Ez| y n1|8(AV0jxU&hz=Hw 9\VMwwh!B lsJB&)C|N!!Xr&K{k9i[MU[oKSk&X2EUxkvlM~W 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. {YO2GMP!BJMP(!/(q@>6 0 1 $10 to $50 to extract a tooth. Contact Us. 4+t?1zxn nmZn5&xUAX5N(;a,r}=YUUA?z r[ $ 0000113149 00000 n 6p6@-_2PA p-S:{c:=q|%~nH09ML{Z 'zS'-'&w.&Xu-.@N G We encourage you to select a primary dentist at the time of enrollment. Search for a dentist by name, specialty, ZIP code or the number of miles you are willing to travel. Payments Information 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. Unlisted, unspecified and nonspecific codes should be avoided. *v:G)JeU%IcRr)\%Ts6q^HpCw-yAuYxU'`ho(7;v};}%-`Fuak`Htf,i1+S|@n-2yC%\rk&(NV;*_(bH *-y;tKMJE-V4"%!GUTEj)/3R$F`}C f0]o~lb>9=Grn5+;X@:D?CwX}/fb'e[=A3[ ~m;j\ZOE%H8RsZg ~mH.l%:~EYwO-$Hcm6dqaW[dc( z Links to various non-Aetna sites are provided for your convenience only. All Rights Reserved. Visit our Forms and publications page to download authorization forms. Yes. Jump to the first list item for each letter: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z. Applicable FARS/DFARS apply. The secondary plan acts like a supplement to the primary plan. MetLife Vision contracted providers allow full and equal If this occurs, please refer to the most recent guide. startxref LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). 0000036990 00000 n 206 0 obj <>stream Web*** Your dentist says you need a full X-Ray and his usual fee is $175*** What is a participating PDP dentist? Or contact Member Services for coverage details. Ho0?4$#UVCr!bf! B[@U=7Y>6.vf Aetna's 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). endstream endobj startxref Network dentists are paid contracted fees. WebProvider Agreement Fee Schedules (Please reference the fee schedule noted in your provider agreement, and if appropriate, check the CMS website to review the fee schedule for Medicaid and Medicare Advantage health plans.) How does the plan save me money? \-.m\EqYt0.\fj JR WebSchedule of Benefits . Applicable FARS/DFARS apply. 0000017206 00000 n WebMetLife has the largest range of dental insurance plans and providers among dental insurance organizations. Do you want to continue? Treating providers are solely responsible for medical advice and treatment of members. To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with in-network providers. Log in to find a dentist who accepts your coverage. Metropolitan Life Insurance Company, New York, NY 10166 Some subtypes have five tiers of coverage. Preferred Dentist Program - MetLife Periodontal maintenance is for patients whove previously had periodontal treatment. (For example, if you change your PCD on April 15, the change will take effect May 1. You must contact us. The information you will be accessing is provided by another organization or vendor. 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. 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). This is called an extension of benefits provision. Others have four tiers, three tiers or two tiers. Check your plan documents or call Member Services for details. other economic conditions. Provider Quick Reference Guide Virginia members: In Virginia, DMO is called DNO (Dental Network Only). It is only a partial, general description of plan or program benefits and does not constitute a contract. 0000000016 00000 n ;j183 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. 0000037280 00000 n If you do not intend to leave our site, close this message. WebDenteMax is one of the largest leasable dental PPO networks in the United States. The ABA Medical Necessity Guidedoes not constitute medical advice. %PDF-1.7 % Find your dentist now in Aetnas large nationwide network. For fee schedule and rate questionsEmail:ProfessionalRates@hca.wa.gov, For all other provider questionsMedical Assistance Customer Service Center (MACSC)Online: secure formPhone: 1-800-562-3022, Website feedback: Tell us how were doing, Copyright 2023 Washington Health Care Authority, I help others apply for & access Apple Health, Apple Health for Workers with Disabilities (HWD), Medically Intensive Children's Program (MICP), Behavioral health services for prenatal, children & young adults, Wraparound with Intensive Services (WISe), Behavioral health services for American Indians & Alaska Natives (AI/AN), Substance use disorder prevention & mental health promotion, Introduction overview for general eligibility, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services & supports (LTSS) manual, Medical plans & benefits (including vision), Life, home, auto, AD&D, LTD, FSA, & DCAP benefits. In Illinois, DMO plans provide limited out-of-network benefits. "H9 !dQ &`,[f*#@$c VvDxAl@&FY`)g c %%EOF You may still elect to receive services from a non They arent a PCD. interpreter services at no cost. 0000039476 00000 n Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 0000072009 00000 n endstream endobj 4796 0 obj <>stream Yes, but some plans may limit the benefit to certain teeth. cy WebDelta Dental has the largest network of dentists nationwide. HOO1sj^ !CHTww`]%6x7A|!! Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. WebNot all employer groups associated with these Payors will utilize the Connection Dental Network. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern. Find a Vision Provider - mymetlifevision.com Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. WebCritical access information for providers MHCP Fee Schedule (MHCP Fee Schedule (dental codes begin on page 55 of the PDF) Fraud, Waste, and Abuse: Combating Medicare Parts C and D Fraud, Waste and Abuse Training Web Based Training Course 2022 Fraud, Waste and Abuse Attestation Fraud, Waste and Abuse Training Log Additional Resources Hn@})R$R(8I1$o0Z?IT @m$,RRW$_yV? Do you need a PA form? Contact Member Services if you have questions. WebMetLifes Table of Maximum Allowable Charges or Fee Schedule applies to dental procedures performed on eligible members participating in MetLifes Preferred Dentist 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. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. Call Customer Service at 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. "CYhpEObbG`aH??iQSj*{rfLbEdv va[?UZ.Nna!gI\ ,X]5 endstream endobj 4801 0 obj <>stream Find individual dental insurance plans near you with budget-friendly coverage options and get a quote. Dental Every enrolled family member may select their own primary care dentist. If so, we will confirm which plan has primary responsibility for claim payment. rxo @ e(m#GIByY6Cs|@5'C/9GL[sN`8!@d2j Oral surgery You pay 20% of covered services for basic surgery; 50% of covered major surgery. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. H|y\GozfKQgxDxk5Q"E[/P# GYf>WWU]z #Fv;t|*DDG&)07"jnlM&r3fLIsg@L?2t&&:r@p>_hwxwm!1IcNp,<6nfT^IAI. !f"UF =,T).ts 0000136750 00000 n Hn0} Information is believed to be accurate as of the production date; however, it is subject to change. This applies to services for: For more details, review your plan documents. Before you provide certain services, you will need to submit authorization request forms. This means if you have two plans that cover two cleanings per year, you dont have four cleanings per year. ), If you choose a new PCD on the sixteenth day of the month or later, the change will go into effect two months afterward. For information related to withdrawal management services (previously detox), please see the agency's inpatient hospital guide. 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 4792 0 obj <> endobj Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. If not, we will pay as the secondary payor. Reprinted with permission. While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. FAQ | MetLife Signing up is simple and free. 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. Use our billing guides and fee schedules to determine if a PA is required and assist in filing claims. If you need interpretation services and are enrolled in the Preferred Dentist Program (Dental It sets what they can charge for covered services. Please note also that the ABA Medical Necessity Guidemay be updated and are, therefore, subject to change. Federal Dental Insurance | MetLife FEDVIP 2023 *Illinois members: State laws vary with regard to out-of-network benefits. Depending on your plan, you may pay for dental care in one of two ways: There are no deductibles or annual dollar maximums. 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. 0000044035 00000 n Dental Insurance Center - MetLife Direct Referral Dental Verify the spelling of the provider's last name or office name. HTn0?N$vt.taQ"]QI~}kGvc:PXJ ,DDIuEE}%uDp'QMXzm:h?cZH;%*E[*& Members cant choose a pediatric dentist as their PCD. It describes the services you have coverage for under your plan. 1-855-MET-EYE-1. HQK0+.y+B")RaO m!n[d]{1|9s}Z2t6BIe)U$}C`u! This will let you and the dentist know what the benefit will be if the service is done. n[F$6_KZi4k See Physician-related/professional services. CPT only Copyright 2022 American Medical Association. My Dental PPO - MetLife You may choose a new one once a month. You can also contact Member Services to determine if they are eligible under your DMO plan. WebSavings from enrolling in the MetLife Federal Dental Plan will depend on various factors, including the cost of the plan, how often participants visit the dentist and the cost of Dental insurance 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 Fax the request to: 866-668-1214. YN8e#'gxs4`T=>q{J&e-v%w+lC**hvD(5'-*GK v` Some services have this type of restriction. 0000044706 00000 n (Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide. This Agreement will terminate upon notice if you violate its terms. 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. endstream endobj startxref Dental WebJuly 1, 2022 to present Mobile anesthesia for dental services billing guide; Fee schedules. endstream endobj 4795 0 obj <>stream A dentist's reimbursement is a combination of: We have an arrangement with our DMO providers. &,MJtN-F;+U_t+|\b2*M-r!N66;ZWFl\4)*8jw#W`hps>O"9nblas %$puu$|0,}kd4$p$ap,KU{. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. 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. Therefore, it is crucial to verify benefits and eligibility with the Payor.
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