metlife dental fee schedule 2020 for providers

For telehealth policies and FAQs, see Telehealth on this page. 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%. 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. Others have four tiers, three tiers or two tiers. Web*** Your dentist says you need a full X-Ray and his usual fee is $175*** What is a participating PDP dentist? For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page. If we have primary responsibility, we will pay as the primary payor. 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). Dental HMO/Managed Care Plans | MetLife 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. Provider billing guides and fee schedules - Washington They may differ by plan. Fax the request to: 866-668-1214. If you are a participating provider with one or more dental benefit plans, you may want to negotiate with those 0000038958 00000 n ?LkG1/p#- -vBw|4W:AB Q=,AfU3mknmwQn%z7 Dental 0000025338 00000 n Direct Referral Dental HtTYo@~0IOHC They do so as if there is no secondary payor. endstream endobj 4797 0 obj <>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 4798 0 obj <>stream The AMA is a third party beneficiary to this Agreement. The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. WebAmount of every $100 in premiums used to pay for claims and administration for the year ending Dec. 31, 2017 You can still visit any licensed dentist, but your out-of-pocket costs may be higher if you choose a non-PPO dentist. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). To change your PCD, log in to your member website. 0000001836 00000 n Go to the American Medical Association Web site. P|!(}!h}qsPq!F#($FikLuJs?nSG^w;jp*B3&x!W x}k}l~'W)+~KZnsN1MVqy G8O,'"Gg Q 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. 0000032811 00000 n 0000113149 00000 n To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with in-network providers. You can also view and share your digital ID card from the Aetna Health app. RNa: endstream endobj 205 0 obj <>/Filter/FlateDecode/Index[17 146]/Length 27/Size 163/Type/XRef/W[1 1 1]>>stream 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. Download the free app today. 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. For previous versions, email us applehealthpharmacypolicy@hca.wa.gov. access to covered services, including insureds with disabilities as Information is believed to be accurate as of the production date; however, it is subject to change. If you had coverage under a previous insurance carrier, youll have coverage for certain services by that plan even after your Aetna coverage begins. 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. This search will use the five-tier subtype. WebJust select a participating dentist at enrollmentthen refer to your Schedule of Benefits to see what's covered and your costs. The Apple Health PDL can be found on the agency's Apple Health PDL page. Check your Aetna Summary of Benefits. How do I notify SEBB that my loved one has passed away? 0000001677 00000 n CPT only copyright 2015 American Medical Association. Select one of the SafeGuard DHMO Plans or one of the MetLife WebPlease note all requested contact information is for the provider * Due to contractual requirements, MetLife is prevented from soliciting certain providers. Depending on your plan, you may pay for dental care in one of two ways: There are no deductibles or annual dollar maximums. If so, the primary care doctor will arrange it. Visit the secure website, available through www.aetna.com, for more information. 0000037280 00000 n Rates | MetLife State of Florida Employees | MetLife For questions about billing guides, contact Medical Assistance Customer Service Center (MACSC) online or at 1-800-562-3022. 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. Find a Vision Provider - mymetlifevision.com 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. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. WebFind a Dentist. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis. Notice: Past billing guides may have broken links. Applicable FARS/DFARS apply. Please see your plan documents. Under these circumstances, dental offices may see the need to adjust their fee schedules. _t \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 WebYou can obtain an updated procedure charge schedule for your area via fax by dialing 1-800-942-0854 and using the MetLife Dental Automated Information Service. 0000000016 00000 n Compare dental plans | Washington State Health Care Authority Why? H=o0w7S4oA2dhQ,QITEF}v@DN/8LBl^K]H*f:J]yDyS{dZ>L80|8xa@c7iCSY_yLdZ~2}e$LJV\+8CG09s^@wg8pn@\O9C3b\ O1^7TR6:'o9vS rp:QM{9l-k[[@szQV[*P/0chT}($^X'F-Bw)t]V[atF5]@R,hYxk,7Ge^AF*Ul. Bzb:5Gl8%bYYFMG`L"J/rrkBlF)ltPBVW oz Some plans exclude coverage for services or supplies that Aetna considers medically necessary. 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. Metlife - Member Dental Plan Benefits - Member Benefits 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. 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 4812 0 obj <>/Filter/FlateDecode/ID[]/Index[4792 37]/Info 4791 0 R/Length 101/Prev 537656/Root 4793 0 R/Size 4829/Type/XRef/W[1 3 1]>>stream 0000048067 00000 n Discover the best option: HMO, PPO and TakeAlong Dental 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. DNO (Dental Network Only) in Virginia is not an HMO. As a MetLife Vision customer you can access language HW$WtM7GmFx4;c}""ztl3*_}"_^_Vkj*[iBK+i?n~/_-la6l{^}m>lq><9n?[{*w^G{e7+Q1V\tm8Vxp7%^t9u(28~Z6v{uf{T% 59Wv_[\}#=a.E1hqYM"8dT1!`9~]hGuDKGgyQ\knr[{tEr:Ad^KbP\9RuCn,sSvjkP(G#OJt3ooQc 1(*@v However, in order to receive maximum benefits, members must select and have care coordinated by a participating primary care dentist. 0000001199 00000 n The member's benefit plan determines coverage. Your plan may have a coordination of benefits provision. Your and Your Aetna Inc. and its affiliated companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. Hn@})R$R(8I1$o0Z?IT @m$,RRW$_yV? You may choose a new one once a month. If you choose a new PCD on or before the fifteenth of the month, the change will go into effect on the first day of the following month. Dental This Agreement will terminate upon notice if you violate its terms. 0 0000044035 00000 n ? Yes. All services deemed "never effective" are excluded from coverage. WebWorldwide dental coverage and plans with no deductible New Hires have 60 days to choose benefits. You can see if your plan has a work-in-progress exclusion. See Inpatient Prospective Payment System (IPPS) on the Hospital reimbursement page. xref general dentist or specialist who meets MetLifes strict credentialing endstream endobj 4805 0 obj <>stream Treating providers are solely responsible for medical advice and treatment of members. If not, we will pay as the secondary payor. trailer New and revised codes are added to the CPBs as they are updated. You can reach them at the number on your ID card. hbbd```b``v> >d(XM|&c0L*e$li6"A@Lg` hT WebYikes, something went terribly wrong!!! Include North/South/East/West with address if appropriate. It is only a partial, general description of plan or program benefits and does not constitute a contract. endstream endobj 4806 0 obj <>stream (For example, a change made on April 16 will take effect June 1.). Yes, but some plans may limit the benefit to certain teeth. For other specialists, a referral may be necessary. You can get a Summary of Benefits from your employer that provides your insurance. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. 0 G TmEg=boq1c8-,4%n (x@q U?eVzfK@X^=|?UOeq}:C |zYlK$"91q''o%$D?('N.. os yI"f]Ez| y n1|8(AV0jxU&hz=Hw 9\VMwwh!B lsJB&)C|N!!Xr&K{k9i[MU[oKSk&X2EUxkvlM~W Dental m-4f'f{">H746Z5apg`u0? WebDenteMax is one of the largest leasable dental PPO networks in the United States. 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. Applicable FARS/DFARS apply. ;j183 Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. endstream endobj 4795 0 obj <>stream Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search. Plus, you'll enjoy: More than 400 covered services 2. For questions about rates or fee schedules, email ProfessionalRates@hca.wa.gov. endstream endobj 164 0 obj <>/Metadata 15 0 R/Pages 14 0 R/StructTreeRoot 17 0 R/Type/Catalog/ViewerPreferences<>>> endobj 165 0 obj >/PageTransformationMatrixList<0[1.0 0.0 0.0 1.0 -306.0 -396.0]>>/PageUIDList<0 152>>/PageWidthList<0 612.0>>>>>>/Resources<>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 166 0 obj [/Separation/PANTONE#20376#20C/DeviceCMYK<>] endobj 167 0 obj [/Separation/PANTONE#20347#20C/DeviceCMYK<>] endobj 168 0 obj [/Separation/PANTONE#202995#20C/DeviceCMYK<>] endobj 169 0 obj <> endobj 170 0 obj <>stream

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