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

[vic120]

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

 

[TwoCents]

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

You've heard of CPT codes for medical, right? CDT codes are the dental equivalent. ADA = American Dental Association.

 

[vic120]

You've heard of CPT codes for medical, right? CDT codes are the dental equivalent. ADA = American Dental Association.

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

 

[Chazm]

Aetna puts the full dental coverage in their EOB’s

 

[vic120]

Aetna puts the full dental coverage in their EOB’s

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

 

[somarco]

Here are CDT codes.
https://www.floridabluedental.com/pdfs/providers-pdfs/plans-manuals-cdtguides/FCL STANDARD CDT 01-2019 final.pdf

You are probably not getting an answer because the folks at Aetna don't know.

Even if they did they probably would not tell.

That's like giving you the answers to the test questions.

 

[vic120]

Here are CDT codes.
https://www.floridabluedental.com/pdfs/providers-pdfs/plans-manuals-cdtguides/FCL STANDARD CDT 01-2019 final.pdf

You are probably not getting an answer because the folks at Aetna don't know.

Even if they did they probably would not tell.

That's like giving you the answers to the test questions.

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]

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

 

[ICACharleston]

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.

 

[vic120]

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.

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