metlife dental fee schedule 2020 for providers

Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider. Log in to your member website first to get personalized results. _t Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider. This information is neither an offer of coverage nor medical advice. If you need more information, contact Member Services. WebThe sequestration reduction amount for each affected claim will be identified on the explanation of remittance healthcare providers receive from Humana. 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. 163 44 If we have primary responsibility, we will pay as the primary payor. WebCan I get an estimate of my out-of-pocket expenses? CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. Dental \-.m\EqYt0.\fj JR My Dental PPO - MetLife 0000142900 00000 n Some plans exclude coverage for services or supplies that Aetna considers medically necessary. When you go to or call the dentist, tell the office staff that you have Aetna Dental DMO. b-4) \0)0=6AywC(>rdN61a0X5AxwYdF70Lgc;e9f ``x@ W6 Dental endstream endobj 4806 0 obj <>stream However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. 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. 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. 0000044706 00000 n A dentist's reimbursement is a combination of: We have an arrangement with our DMO providers. WebOral surgery. 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. 20% PPO and out-of-state; 30% non-PPO. general dentist or specialist who meets MetLifes strict credentialing 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. <<5AE96FDB43CC14498BFAFB7B8207E05A>]/Prev 310465/XRefStm 1499>> When billing, you must use the most appropriate code as of the effective date of the submission. WebNot all employer groups associated with these Payors will utilize the Connection Dental Network. To find out, just call Member Services. 0000104077 00000 n Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change. For previous versions, email us applehealthpharmacypolicy@hca.wa.gov. This material is for information only. 0000086757 00000 n No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 0000035971 00000 n %PDF-1.7 % The information you will be accessing is provided by another organization or vendor. HW$WtM7GmFx4;c}""ztl3*_}"_^_Vkj*[iBK+i?n~/_-la6l{^}m>lq><9n?[{*w^G{e7+Q1V\tm8Vxp7%^t9u(28~Z6v{uf{T% 59Wv_[\}#=a.E1hqYM"8dT1!`9~]hGuDKGgyQ\knr[{tEr:Ad^KbP\9RuCn,sSvjkP(G#OJt3ooQc 1(*@v Signing up is simple and free. 0000036990 00000 n Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. HTn0?N$vt.taQ"]QI~}kGvc:PXJ ,DDIuEE}%uDp'QMXzm:h?cZH;%*E[*& This guide was discontinued July 1, 2020. You can see if your plan has a work-in-progress exclusion. See Physician-related/professional services.). Dental Provider Forms and Downloads Links to various non-Aetna sites are provided for your convenience only. CPT only Copyright 2022 American Medical Association. 6p6@-_2PA p-S:{c:=q|%~nH09ML{Z 'zS'-'&w.&Xu-.@N ;^{s4)|I6gPvJ=x endstream endobj 4800 0 obj <>stream See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page. MetLife Vision contracted providers allow full and equal Plus, you'll enjoy: More than 400 covered services 2. P|!(}!h}qsPq!F#($FikLuJs?nSG^w;jp*B3&x!W x}k}l~'W)+~KZnsN1MVqy G8O,'"Gg Q 0000050787 00000 n They arent a PCD. Direct Referral Dental Plan* MET185A. City of Virginia Beach and Virginia Beach City Public Schools Before you provide certain services, you will need to submit authorization request forms. Please contact Member Services. Yes. It is only a partial, general description of plan or program benefits and does not constitute a contract. In the event that a member disagrees with a coverage determination, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law. %%EOF Compare dental plans | Washington State Health Care Authority The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. Log in to find a dentist who accepts your coverage. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government. 0000025338 00000 n YN8e#'gxs4`T=>q{J&e-v%w+lC**hvD(5'-*GK v` Each DMO member must select a PCD. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. 0000043626 00000 n t|%y,$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. Ah{sX+AN=SPajl}la3)GfZC^T However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans. other economic conditions. Florida hb```, cb.0800(_^Xf5VtUm]81JRtsFGIGcSPaf@Z F y'f??XtO?T)c10 i pg*00Ok D & Predeterminations may not be available in all states. Spell out street names and abbreviations (State Highway 249 instead of SH 249). 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. Check your plan documents or call Member Services for details. Include North/South/East/West with address if appropriate. ?LkG1/p#- -vBw|4W:AB Q=,AfU3mknmwQn%z7 Register and log in to your member website. WebCleaning for adults is covered every three months. 4828 0 obj <>stream How does the plan save me money? There are several types of coordination of benefits provisions. Some services have this type of restriction. To find out additional fee information on common procedures in your area, the process is simple Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept". Download the Pharmacy Information Authorization form (13-835A). 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. trailer The AMA is a third party beneficiary to this Agreement. This is called an extension of benefits provision. 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. 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. 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). (Effective October 1, 2015 this guide was merged into the physician-related services/health care professional services billing guide. 0000050892 00000 n GEHA 0000001836 00000 n 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. 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 CPT only copyright 2015 American Medical Association. CPT is a registered trademark of the American Medical Association. 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( If this occurs, please refer to the most recent guide. I was billed more than the standard $150 co-payment for a crown. endstream endobj startxref 0000072009 00000 n 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. Unlisted, unspecified and nonspecific codes should be avoided. 163 0 obj <> endobj LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT"). Or you can contact Member Services. Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change. Applicable FARS/DFARS apply. Verify the spelling of the street name or city. endstream endobj 4804 0 obj <>stream Go to the American Medical Association Web site. 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. 0000001499 00000 n Members cant choose a pediatric dentist as their PCD. Ooops!!! - MetLife metlife dental claim form NCFlex MetLife Triple Options Booklet and FAQs NCFlex MetLife Dental International Travel Assist Flyer MetLife Dental Low Option Certificate 01 01 20 MetLife Dental Low Option Certificate UNC Chapel Hill 01 01 20 MetLife Dental Classic Option Certificate 01 01 20 0000001199 00000 n WebJust select a participating dentist at enrollmentthen refer to your Schedule of Benefits to see what's covered and your costs. Your and Your 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. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements. 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. 4792 0 obj <> endobj Notice: Past billing guides may have broken links. L0621014064[exp0622][All States]. endstream endobj startxref MetLife hbba`b``30 Ga HtTYo@~0IOHC WebCoordination of benefits provisions in dental benefits plans are a set of rules that are followed when a patient is covered by more than one dental benefits plan. WebPlease note all requested contact information is for the provider * Due to contractual requirements, MetLife is prevented from soliciting certain providers. 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 Search for a dentist by name, specialty, ZIP code or the number of miles you are willing to travel. os yI"f]Ez| y n1|8(AV0jxU&hz=Hw 9\VMwwh!B lsJB&)C|N!!Xr&K{k9i[MU[oKSk&X2EUxkvlM~W Please be sure to add a 1 before your mobile number, ex: 19876543210, Coinsurance You pay a percentage of covered expenses, Crowns and fixed bridgework when the teeth were prepared before your Aetna coverage began, Appliances (such as dentures) when the impression was taken before your Aetna coverage began, Root canal therapy when the tooth's pulp chamber was opened before your Aetna coverage began.