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Aetna Dental members do not need a member ID card to get dental care. When you go to the dentist, tell the office staff that you have Aetna Dental and they will verify your coverage.
You can view and print your ID card from your member website. Signing up is simple and free.
You can also view and share your digital ID card from the Aetna HealthSM app. Download this free app today at the App Store or Google Play.
If your plan has a coordination of benefits provision, we confirm which plan has primary responsibility for claim payment. If we have primary responsibility, we pay as the primary payor. If not, we pay as the secondary payor.
The primary payor pays claims as it normally would, as if there were no secondary payor. The secondary plan acts like a supplement to the primary plan.
If you are enrolled in two dental plans, and each plan covers two cleanings per year, you are not entitled to four cleanings per year.
Please note that there are several types of coordination of benefits provisions. They may differ by plan. If you need more information, please contact Member Services using the number on your ID card.
No.
You can find a network dentist using our online directory. For personalized results, first log in to your secure member website. Search for a dentist by name, specialty, zip code or the number of miles you are willing to travel.
Log in to find a dentist who accepts your coverage
Network Dentists
Network dentists have agreed to offer certain services at a negotiated rate. If you visit a network dentist, you generally pay less out of pocket.
Out-of-network dentists
Dentists who are not in our network may bill you their normal fee for procedures. Your plan provides benefits using amounts that we have set as the "recognized charge" for each service in your geographic area. When we set the "recognized charge" we may consider other factors, including the prevailing charge in other areas. The amount of our "recognized charge" does not suggest your dentist’s fee is not reasonable and proper.
Your dentist may bill you for the difference between his or her normal fee and our "recognized charge." This amount is not covered, and you must pay it.
If you are enrolled in a PPO Max plan, your out-of-network benefits will be based on the standard rates for network dentists in that geographic area. Please see your plan document or contact Member Services for details.
Your Aetna Summary of Benefits describes the services that are covered under your plan. You can get a Summary of Benefits from the employer that is providing your insurance.
Yes, but some plans may limit the benefit to certain teeth. Contact Member Services if you have questions.
If the teeth were lost or extracted before your coverage began, then services to replace them may not be covered by your plan. This applies to first-time dentures, fixed or removable bridges, and implants. For more details, contact Member Services or review your plan documents.
Please see your plan documents or contact Member Services for coverage details.
Yes. Some services have this type of restriction. Please see your plan documents or contact Member Services for details.
If you were covered under a previous insurance carrier, certain services will be covered by that plan even after your Aetna coverage begins. This is called an extension of benefits provision. These services include:
If you had no coverage when you started treatment for a service, that service may not be covered under your Aetna plan. Contact Member Services to see if your plan has a work-in-progress exclusion.
If more than one service is needed to fix a problem, most services are considered separately.
Have your dentist send a request for a pretreatment estimate (predetermination) to us. This will let you and the dentist know what the benefit would be if the service were done. You or your dentist may also call Member Services at the number on your ID card.
Periodontal maintenance is for patients who have previously been treated for periodontal disease.
Page last reviewed January 5, 2016
Texas Members: In Texas, the Preferred Provider Organization (PPO) plan is known as the Participating Dental Network (PDN).
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates (Aetna).
This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.
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