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. Metropolitan Life Insurance Company, New York, NY 10166 Links to various non-Aetna sites are provided for your convenience only. 0 0000050717 00000 n For questions about rates or fee schedules, email ProfessionalRates@hca.wa.gov. In case of a conflict between your plan documents and this information, the plan documents will govern. 0000017092 00000 n You can reach them at the number on your ID card. 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. 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. To find a retail location, search by office name. Treating providers are solely responsible for medical advice and treatment of members. The secondary plan acts like a supplement to the primary plan. WebYikes, something went terribly wrong!!! (For example, if you change your PCD on April 15, the change will take effect May 1. hbbd```b``v> >d(XM|&c0L*e$li6"A@Lg` hT If not, we will pay as the secondary payor. I was billed more than the standard $150 co-payment for a crown. You can reach them at the number on your member ID card. Your benefits dont double if you are enrolled in two dental plans. Hn0R`~(dQQl\0H5oKtFA?v>4.zL >.K;J+p0eLK!YWU-`}\~nxqC79*G: >$LAFMEECJ.&rwBx77C(gOI CHAwl"4Q !b p^y2gp#M 206 0 obj <>stream Verify the spelling of the street name or city. 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. After you complete a service, you file claims through the ProviderOne portal. P|!(}!h}qsPq!F#($FikLuJs?nSG^w;jp*B3&x!W x}k}l~'W)+~KZnsN1MVqy G8O,'"Gg Q You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Aetna Inc. and itsaffiliated companies are not responsible or liable for the content, accuracy or privacy practices of linked sites, or for products or services described on these sites. They will be able to verify your coverage. 0qPWp:dW5 ;6V]BpJ#@DE"?Fo=+57]>>=@^{"p5yM~'A}t`)6ts(T^ `p]~@5zPn/VO=RB;#Gkj@!bg~7s}f You can see if your plan has a work-in-progress exclusion. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. endstream endobj 205 0 obj <>/Filter/FlateDecode/Index[17 146]/Length 27/Size 163/Type/XRef/W[1 1 1]>>stream CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. WebWhen is periodontal maintenance covered? 4812 0 obj <>/Filter/FlateDecode/ID[]/Index[4792 37]/Info 4791 0 R/Length 101/Prev 537656/Root 4793 0 R/Size 4829/Type/XRef/W[1 3 1]>>stream Your benefits plan determines coverage. This applies to services for: For more details, review your plan documents. Visit the secure website, available through www.aetna.com, for more information. For general Apple Health and behavioral health guidance, visit our Information about novel coronavirus (COVID-19) webpage. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. RLaVHQB-JS=*ccYqE,cD98q:A-H}D+&\jC80n 3"Dtd(DDhy +pE8ai:H,[9"XX$'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 4828 0 obj <>stream Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. See Physician-related/professional services.). Register and log in to your member website. Search our network GEHA's 2023 Dental Benefits Need help choosing a plan? The Apple Health PDL can be found on the agency's Apple Health PDL page. 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). If you need interpretation services and are enrolled in the Preferred Dentist Program (Dental The ADA anticipates that the costs of providing care will substantially increase for many dental procedures. Orthodontic treatment from a participating provider doesnt require referrals. WebYour primary care dentist will provide all of your routine dental care and any copayment or discounted charges will be paid at the time of service If you need a specialty dentist, you may receive a 25 percent discount by using one of the participating specialty dentists from %%EOF 779 0 obj <> endobj If this occurs, please refer to the most recent guide. For telehealth policies and FAQs, see Telehealth on this page. Virginia members: In Virginia, DMO is called DNO (Dental Network Only). 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. The $150 co-payment is for a plain metal crown. WebNot all employer groups associated with these Payors will utilize the Connection Dental Network. Oral surgery You pay 20% of covered services for basic surgery; 50% of covered major surgery. 0000037168 00000 n 0 0000072009 00000 n In Illinois, DMO plans provide limited out-of-network benefits. 0000020858 00000 n For step-by-step instructions on completing a PA, visit our Prior authorization (PA) page. "lkBJbQkQ~A~>VKmdCD"*>YF.%Vv]-w0 0000113149 00000 n ?LkG1/p#- -vBw|4W:AB Q=,AfU3mknmwQn%z7 general dentist or specialist who meets MetLifes strict credentialing Top 3 reasons to choose Aetna Dental Your choice of any licensed dentist, in or out of network, worldwide, including virtual providers 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.
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