Aetna MA Dental in TX any one know if it covers Implants?

Aug 15, 2019

  1. vic120
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    vic120 Guru

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    I am getting no info from Aetna, Answers range from When a prospect is a client he can call member services to it depends on ADA code, When I ask what is an ADA code not getting an answer

    I have a prospect who is trying to decide on Aetna HMO plan with $1,700 dental and Aetna PPO plan that has Part B reduction

    The who reason for the dental would be for implants If it won't cover that He will go part B reduction.

    However, 3 and half days and I am pulling my hair out trying to find an answer
     
    vic120, Aug 15, 2019
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  2. TwoCents
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    You've heard of CPT codes for medical, right? CDT codes are the dental equivalent. ADA = American Dental Association.
     
    TwoCents, Aug 15, 2019
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  3. vic120
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    vic120 Guru

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    I got it, however, the problem is if they couldn't even tell me that, They def arent telling me how to find out what codes are acceptable or not

    Seems to me it should not be this difficult to find out if implants are covered or not, The prospect soon will probably think I cant do the job

    Seems to me it should be more simple, Its implants what's the difference from one to another as far as if it's covered
     
    vic120, Aug 15, 2019
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  4. Chazm
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    Aetna puts the full dental coverage in their EOB’s
     
    Chazm, Aug 15, 2019
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  5. vic120
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    vic120 Guru

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    It does say things it covers include, and then lists some things, However, it does not say it does not cover things, not on the list

    It does not list exclusions and neither does the evidence of coverage

    I ask because I had an issue years ago on a dental that also did not list exclusions and found out that it did not cover implants

    I did find out they do cover implants with the right ADA Code, However I cannot find out what the right ADA code is and what a reason one would be the right one or the wrong one
     
    vic120, Aug 15, 2019
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  6. somarco
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    somarco GA Medicare Expert

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    somarco, Aug 15, 2019
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  7. vic120
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    vic120 Guru

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    Ok but how do I know which codes are covered with Aetna or not if they won't tell me or give me an Aetna document on covered codes?

    And is CDT codes the same as an ADA code?
     
    vic120, Aug 15, 2019
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  8. vic120
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    Ok this is finally straightened out, I just got an email with a better explanation

    If it has ADA code Any ADA code, it will be covered If it does not have an ADA code it will not

    Finally have something to work with
     
    Last edited: Aug 15, 2019
    vic120, Aug 15, 2019
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  9. ICACharleston
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    I was thinking that with the price of implants and a $1700 cap, it would hardly matter. But the network discount might be substantial. And if the final crown was in a new year that could be covered too.
     
  10. vic120
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    vic120 Guru

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    No Network though it's a reimbursement deal. He may do that His Effective will be Oct 1st. He wanted to try and get the $1,700 this year and Jan too If it's still available next year

    They also have a Part B reduction of $104 per month there as well
     
    vic120, Aug 15, 2019
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