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Choosing A Primary Care Dentist
You can feel confident choosing a dentist for you and your family from our extensive network of independent primary care dentists (PCD) in private practice. That's because primary care dentists must first meet our participation standards before they can join our network.
It's no easy task. When a dentist asks to join our network, we do a review of the dentist's licenses, education and other credentials. Plus, a committee including dentists who also care for Aetna Dental Inc. (the Plan) members reviews information about the dentist and the office. Dentists who are in our network do not work for the Plan. They provide care in their own private offices.
And, because our goal to help improve access to appropriate care is an enduring commitment, participating primary care dentists must periodically undergo a recredentialing process. You are encouraged to ask your dentists and other providers about their education, training and work experience. You are also encouraged to ask your dentists and other providers how they are compensated for their services, including whether their arrangements include any financial incentives for managing costs.
You may change your primary care dentist at any time by calling the toll-free number on your Aetna Dental Inc. ID or wallet card.
Participating Providers
You should consult the primary care dentist you have selected to help determine the dental care you need. In some plans, in order to maximize your benefits, you may need to obtain a referral from the primary care dentist you have selected before seeking non-emergency specialty care. If your plan requires a referral for specialty care, please note the following:
- You should discuss referrals with your primary care dentist to understand what specialty services are being recommended and why with the exception of an orthodontist. You do not need a referral to see an orthodontist.
- If the specialty dentist recommends additional treatments or tests that are covered benefits, you may need another referral from your primary care dentist before receiving the services. If you need another referral for these services and do not get one, you will be responsible for payment.
- In some rare instances, your primary care dentist may want to refer you to a nonparticipating provider for covered services that are not available within the network. Coverage for services from nonparticipating providers requires prior approval by the Plan, in addition to a special nonparticipating referral from your primary care dentist. When properly pre-authorized, these services are covered, less any applicable copayment.
- You cannot request referrals for specialty dentists after you visit them. Therefore, to receive maximum coverage, you need to see your primary care dentist first before seeking specialty care (except in an emergency) and get appropriate pre-approval from the Plan for certain services. Under some plans, you may be able to go directly to a specialty dentist without a referral and receive a lower level of benefits for covered services. However, you may be able to reduce your out-of-pocket expenses considerably by using the participating providers listed in this directory. Please refer to your specific plan documents for information on non-referred benefits.
Emergency Care
Emergency care is the dental services administered in a dentist's office, dental clinic, or other comparable facility to evaluate and stabilize dental conditions of a recent onset and severity accompanied by excessive bleeding, severe pain, or acute infection that would lead a prudent layperson, possessing average knowledge of dentistry to believe that immediate care is needed. Covered Persons needing Emergency Care should proceed as follows:
(1) Whenever possible, the Covered Person should telephone his primary care dentist to arrange an emergency appointment.
(2) If it is not possible to contact his primary care dentist, the Covered Person should contact the nearest dental provider. Coverage is subject to the terms which follow.
When care for an emergency condition is received from a primary care dentist, a benefit will be paid and will be based on the negotiated charge with the primary care dentist. The member will be responsible for the member copay indicated in the Dental Care Schedule.
When care for an emergency condition is received from a dental provider other than a primary care dentist, a benefit will be paid and will be based on the Reasonable Charge for such care. The member will be responsible for the member copay indicated in the Dental Care Schedule.
Payment will be made only if all of the following rules are met:
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The care given is intended to stabilize the emergency condition and to provide palliative relief, until the Covered Person can be seen by the primary care dentist.
- An itemized bill is submitted to the Plan. It must describe the care involved. Depending on whether or not benefits are assigned to the provider, the bill may be submitted by either the provider or the Covered Person.
Representatives from Member Services are trained to answer your questions and to assist you in using the Plan properly and efficiently. After you receive your ID or wallet card, you can call the Member Services toll-free number on the card when you need to:
- Ask questions about benefits and coverage.
- Notify us of changes in your name, address or telephone number.
- Change your primary care dentist or office.
- Obtain information about how to file a complaint.
Complaint Process
Our complaint resolution process is designed to address member coverage issues, complaints and problems. If you have a coverage issue or other problem, call the Member Services toll-free number.
Internet Access
You can use the Internet to access information about the Plan and conduct business with our Member Services department electronically. Access our Internet site at www.aetna.com. By sending a request to Member Services, you can change your primary care dentist.
With Internet access, you can also use DocFind®, the Plan's electronic provider directory on our website www.aetna.com/docfind to find a dentist in your area. Plus you can obtain other useful information not found in this directory, such as where a dentist went to dental school. This information is updated three times a week.
How to Use This Directory
This Directory Contains the Following Sections:
Listing of Participating Primary Care Dentists
The individual listings are sorted as follows:
a. By state (if applicable)
b. By county
c. By major city or town
d. By specialty
In this section, you'll find the address and phone number of a specific dental office. This section will be helpful to you in choosing a primary care dentist as required by your plan.
Participating dentists may practice at more than one location. Please contact the Dentist or Office for hours and availability.
Listing of Participating Specialty Dentists
This section is sorted by geography (state, county and/or city), and then by specialty.
Dental Specialties
Please read the following information so you will know from whom or what group of dentists, covered specialty care may be obtained.
General Dentist/Primary Care Dentist
A primary care dentist is a general dentist who a member must select; the primary care dentist is responsible for the diagnosis, treatment, management and overall coordination of services to meet patients' routine dental care needs, the general dentist will help coordinate the necessary referral for the patient. Some services provided by a general dentist are routine exams and cleanings, fillings and simple extractions.
Pediatric Dentistry
A pediatric dentist is a specialty dentist who provides dental care to children from infancy through adolescence.
Endodontics
An endodontist is a specialty dentist who deals with the prevention, diagnosis and treatment of disorders of the dental pulp. A common endodontic procedure is root canal therapy.
Periodontics
A periodontist is a specialty dentist that deals with the examination, diagnosis and treatment of the bone and gum tissues that support the teeth.
Orthodontics
An orthodontist is a specialty dentist who is responsible for the diagnosis, prevention, interception and treatment of all forms of misalignment of the teeth and surrounding structures. A common orthodontic procedure is straightening the alignment of the teeth with braces.
Oral and Maxillofacial Surgery
An oral and maxillofacial surgeon is a specialty dentist who provides diagnosis, surgical treatment and adjunctive treatment of diseases, injuries and defects of the hard and soft tissue of the oral and maxillofacial regions.
Prosthodontics
A prosthodontist is a specialty dentist concerned with the replacement of teeth. Dental prostheses may be either fixed (e.g., crowns and bridges) or removable (e.g., complete or partial dentures).
Notice to Enrollees
Consult Aetna's on-line provider directory for the most current provider listings. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna Dental Inc. (the Plan) or its affiliates. The availability of any particular provider cannot be guaranteed for referred or in-network benefits, and provider network composition is subject to change. Not every provider listed in the directory will be accepting new patients. Although the Plan has identified providers who were not accepting patients as known to the Plan at the time this provider directory was created, the status of a provider's practice may have changed. For the most current information, please contact the selected provider or Member Services at the toll-free number on your ID card.
This material is for informational purposes only and is neither an offer of coverage nor medical advice. It contains only a partial, general description of plan or program benefits and does not constitute a contract or any part of one. For a complete description of the benefits available to you, including procedures, exclusions and limitations, please request a copy of your specific plan documents, which may include the Group Insurance Certificate or Booklet, Group Insurance Policy and any applicable riders to your plan. In case of a conflict between your plan documents and this information, the plan documents will govern. All the terms and conditions of your plan or program are subject to and governed by applicable contracts, laws, regulations and policies. The availability of a plan or program may vary by geographic service area, and not all plans or programs are available in all areas. All benefits are subject to coordination of benefits.
The information in this document is subject to change. In the event of a problem with coverage, members should contact Member Services at the toll-free number on their ID cards for information on how to utilize the complaint procedure when appropriate.
All member care and related decisions are the sole responsibility of participating providers. The Plan does not provide health care services and, therefore, cannot guarantee any results or outcomes.
Dental benefits are provided or administered by Aetna Dental Inc.
