metlife dental fee schedule 2020 for providers

0 WebWhen is periodontal maintenance covered? 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. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. These rules determine New and revised codes are added to the CPBs as they are updated. You are now being directed to the CVS Health site. If not, we will pay as the secondary payor. In Illinois, DMO plans provide limited out-of-network benefits. Others have four tiers, three tiers or two tiers. Or you can contact Member Services. Each covered family member can select their own. hb```b`b`e`eb@ !f(GBC S1(500;1T5~`;4a> O@s'IW5yLrWqcrED]:b53l 2& CEg 120bpg7E'21Jn- (o-ee` y.4 H30-f1p' `[ CPT only copyright 2015 American Medical Association. endstream endobj 4799 0 obj <>stream All Rights Reserved. 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 Hn0R`~(dQQl\0H5oKtFA?v>4.zL >.K;J+p0eLK!YWU-`}\~nxqC79*G: >$LAFMEECJ.&rwBx77C(gOI CHAwl"4Q !b p^y2gp#M We need to authorize the use of a different provider before treatment. 0000050717 00000 n BG[uA;{JFj_.zjqu)Q xref Who can enroll in the plan? 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. endstream endobj startxref _t 0000016913 00000 n b-4) \0)0=6AywC(>rdN61a0X5AxwYdF70Lgc;e9f ``x@ W6 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 This information is neither an offer of coverage nor medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. G How does the plan save me money? WebOral surgery. CMS develops fee schedules for physicians, ambulance services, clinical laboratory services, and durable medical equipment, prosthetics, orthotics, and supplies. Find your dentist now in Aetnas large nationwide network. Illinois DMO is not an HMO. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. 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. 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. WebAll Other Dental Services You Pay $0 In-Network $50 Out-of-Network $50 The maximum amount Guardian will reimburse you for dental services received Limitations and Exclusions (see your policy for further details) We will not pay 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. 0000072473 00000 n In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members. WebMetLife's Preferred Dentist Program allows you to select from a network of dentists who have agreed to charge discounted fees. Please see your plan documents. Members should discuss any matters related to their coverage or condition with their treating provider. endstream endobj startxref They may differ by plan. Visit our Document submission cover sheets page to find the barcode cover sheets required with additional documentation. hb```, cb.0800(_^Xf5VtUm]81JRtsFGIGcSPaf@Z F y'f??XtO?T)c10 i pg*00Ok D & Log in to your member website first to get personalized results. endstream endobj 4804 0 obj <>stream 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. 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. You can also view and share your digital ID card from the Aetna Health app. Find a dentist near Log in to find a dentist who accepts your coverage. 0000072009 00000 n 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. cy P|!(}!h}qsPq!F#($FikLuJs?nSG^w;jp*B3&x!W x}k}l~'W)+~KZnsN1MVqy G8O,'"Gg Q Some services have this type of restriction. 0000036485 00000 n In case of a conflict between your plan documents and this information, the plan documents will govern. endstream endobj 4796 0 obj <>stream Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt. 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. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. Contact Member Services if you have questions. 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. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. The ABA Medical Necessity Guidedoes not constitute medical advice. You can get a Summary of Benefits from your employer that provides your insurance. Call Customer Service at What types of services does the plan cover? Life, home, auto, AD&D, LTD, & FSA benefits, Overview of prior authorization (PA), claims & billing, Step-by-step guide for prior authorization (PA), Program benefit packages & scope of services, Community behavioral support (CBHS) services, First Steps (maternity support & infant care), Ground emergency medical transportation (GEMT), Home health care services: electronic visit verification, Substance use disorder (SUD) consent management guidance, Enroll as a health care professional practicing under a group or facility, Enroll as a billing agent or clearinghouse, Find next steps for new Medicaid providers, Washington Prescription Drug Program (WPDP), Governor's Indian Health Advisory Council, Analytics, research & measurement (ARM) data dashboard suite, Foundational Community Supports provider map, Medicaid maternal & child health measures, Washington State All Payer Claims Database (WA-APCD), Personal injury, casualty recoveries & special needs trusts, Information about novel 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October 1, 2020 to present Childbirth education billing guide, April 1, 2019 to September 30, 2020 Childbirth education billing guide, October 1, 2017 to March 31, 2019 Childbirth education billing guide, View all childbirth education billing guides, January 1, 2007 to present Childbirth education, July 1, 2022 to present Chiropractic services billing guide, October 1, 2020 to June 30, 2022 Chiropractic services billing guide, January 1, 2020 to September 30, 2020 Chiropractic services billing guide, View all chiropractic services for children billing guides, July 1, 2022 to present Chiropractic services for children fee schedule, July 1, 2021 to June 30, 2022 Chiropractic services for children fee schedule, July 1, 2020 to June 30, 2021 Chiropractic services for children fee schedule, View all chiropractic services for children fee schedules, April 1, 2023 to present CRT products and services billing guide, July 1, 2022 to March 31, 2023 CRT products and services billing guide, 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March 31, 2023 Dental-related services program billing guide, October 1, 2022 to December 31, 2022 Dental-related services program billing guide, July 1, 2022 to present Oral Health Connections pilot project billing guide, January 1, 2022 to June 30, 2022 Oral Health Connections pilot project billing guide, October 1, 2020 to December 31, 2021 Oral Health Connections pilot project billing guide, View all OHC pilot project billing guides, July 1, 2022 to present Mobile anesthesia for dental services billing guide, January 1, 2023 to present Dental program fee schedule, October 1, 2022 to December 31, 2022 Dental program fee schedule, July 1, 2022 to September 30, 2022 Dental program fee schedule, July 1, 2022 to present Diabetes education program billing guide, July 1, 2021 to June 30, 2022 Diabetes education program billing guide, April 1, 2021 to June 30, 2021 Diabetes education program billing guide, View all Diabetes Education Program billing guides, July 1, 2022 to present Diabetes 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