Blue Distinction Centers for Substance Use Treatment and Recovery aims to improve patient outcomes and value by focusing on providers across the full continuum of care who deliver and facilitate treatment for substance use disorder, including opioid use disorder. local anesthesia, non-intravenous conscious sedation or analgesia such as nitrous oxide; Dental services arising out of accidental injury to the teeth and supporting structures, except for injuries to the teeth due to chewing or biting of food; Initial installation of a fixed and permanent Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Other fixed Denture prosthetic services not described elsewhere in the certificate; Precision attachments, except when the precision attachment is related to implant prosthetics; Addition of teeth to a partial removable Denture to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Adjustment of a Denture made within 6 months after installation by the same Dentist who installed it; Implants supported prosthetics to replace one or more natural teeth which were missing before such person was insured for Dental Insurance, except for congenitally missing natural teeth; Fixed and removable appliances for correction of harmful habits; Appliances or treatment for bruxism (grinding teeth), including but not limited to occlusal guards and night guards; Diagnosis and treatment of temporomandibular joint (TMJ) disorders. 988 0 obj This symbol denotes a PDF Document. Austin, TX 78735 What's not covered by Part A & Part B? Medicare.gov, last accessed June 10, 2022. Wearing a Suit After a Body-Altering Surgery. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. This surgery makes the stomach smaller. endstream endobj 251 0 obj <. Heres a step-by-step look at what information is in an SBC: You can request a copy of an SBC anytime. (Refer to your dental benefits plan summary for your out-of-network dental coverage.) search a list of these participating dentists online, https://www.metlife.com/support-and-manage/forms-library/, One fluoride treatment per 12-month period for dependent children up to their 14th birthday, Total number of periodontal maintenance treatments and prophylaxis cannot exceed two treatments in a calendar year, For dependent children up to 14th birthday, once per lifetime per tooth area, One application of sealant material every 60 months for each non-restored, non-decayed 1st and 2nd molar of a dependent child up to their 16th birthday, Crown, Denture, and Bridge Repair / Recementations, Initial placement to replace one or more natural teeth, which are lost while covered by the plan, Root canal treatment limited to once per tooth per lifetime, When dentally necessary in connection with oral surgery, extractions or other covered dental services, Except as mentioned elsewhere in certificate, Periodontal scaling and root planning once per quadrant, every 24 months, Your Children, up to age 19, are covered while Dental Insurance is in effect. Whats a Summary of Benefits and Coverage? <>/Filter/FlateDecode/ID[<4A8EC73074B5B2110A00B0B8D090FC7F>]/Index[988 109]/Info 987 0 R/Length 162/Prev 206109/Root 989 0 R/Size 1097/Type/XRef/W[1 3 1]>>stream 0000024943 00000 n Policy form GPNP99 received at a facility maintained by the Policyholder, labor union, mutual benefit association, or VA hospital; Services covered under other coverage provided by the Policyholder; Services for which the submitted documentation indicates a poor prognosis; The following when charged by the Dentist on a separate basis: infection control such as gloves, masks, and sterilization of supplies; or. 1 Sturti / Getty Images Coverage Varies by Insurer Each health plan is different. Gross Receipts Tax 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. <. 0 Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. 0000007939 00000 n Medicare Advantage plans are provided by private companies with approval from Medicare. L0920007743[exp0922][All States][DC,GU,MP,PR,VI] 2020 MSS, Florida office (headquarters) SurgeryPlus offers a variety of medical procedures, including the following: Terms and Conditions | Privacy Statement | Accessibility Statement | Sitemap, Monthly Webinars / Educational YouTube Videos, Making plan changes with a Qualifying Status Change (QSC) Event. You or your dependent use SurgeryPlus to receive a preoperative to post-operative bundled surgical service; SurgeryPlus validates that you or your dependent received the service; and. To get you to the right place, click the link below to indicate whether you are a member of Surgery Direct or Cancer Care Direct. 0000018849 00000 n Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. Coverage includes access to our network of excellent surgeons, consults and appointments with your SurgeryPlus provider, anesthesia, the procedure and facility (hospital) fees. If you are enrolled in a medical option through American (except DFW ConnectedCare) and have a covered surgery coming up, SurgeryPlus will: This is a voluntary benefit available to you if youre enrolled in the Core, Standard, Plus, High Cost Coverage, PPO 80 or PPO 90 medical option. Certain claim and network administration services are provided through Vision Service Plan (VSP), Rancho Cordova, CA. We recommend that you request a pre-treatment estimate for services in excess of $300. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary. 0000015806 00000 n Delaware's Governor Cancellation/Termination of Benefits Weight-Loss (Bariatric) Surgery. You may choose to share the information with your doctor and other medical professionals. If you and your dentist have agreed on a treatment that is more costly than the treatment upon which the plan benefit is based, you will be responsible for any additional payment responsibility. Durable medical equipment (DME) coverage, Medicare.gov, last accessed June 10, 2022. You can ask for a pretreatment estimate. This benefit is available to those enrolled in one of the CEBT EPO, PPO or HDHP medical plans. International dental travel assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with MetLife or any of its affiliates, and the services they provide are separate from the benefits provided by MetLife. Confirm your coverage before you commit to a procedure youre unsure about. Hearing & balance exams, Medicare.gov, last accessed June 10, 2022. The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. 0000006640 00000 n Most common oral surgeries are covered, at least in part, by your dental insurance provider. Some examples of comorbidities include high blood pressure, high cholesterol, obstructive sleep apnea, Type II Diabetes, angina or stroke. Yes. Licensed Humana sales agents are available daily, 8a.m. 8 p.m. %%EOF Whats especially helpful is that every health plan has to use the same outline to show the costs and coverage for each of the plans they offer. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. 866-855-1212 to request a claim form. hb```b``Nf`c`Wcd@ AV(G 2?X%c6g+S@|dHA[&@VS&-,&W\\f9v| **s)S\Ol%5T7A(F 0000001266 00000 n h`06NH+500 trailer You and your dentist will receive a benefit estimate for most procedures while you are still in the office. Board Certification, Specialty Training Requirements, Procedure Volume Requirements, State Sanctions Check, Medical Malpractice Claims Review, Criminal Background Checks, CMS Quality Requirements (Hospital Only), Monthly Network Monitoring. 00k` !" 7500 Rialto Blvd, Building 1 Suite 250 Some general conditions to receive coverage from United Healthcare requires that you meet the following criteria: Have a body mass index over 40 OR. 0000014887 00000 n What happens with my health information? We suggest you discuss treatment options with your dentist before services are rendered, and obtain a pre-treatment estimate of benefits prior to receiving certain high cost services such as crowns, bridges or dentures. Its also possible to get an SBC in another language. However, this depends on the specific type of surgery you need, your dental plan, and your level of coverage. So you may be responsible for any difference in cost between the dentists fee and your plans benefit payment. 0000016018 00000 n These partners are required to comply with all laws protecting privacy. 0000379543 00000 n *Negotiated Fee refers to the fees that participating dentists have agreed to accept as payment in full, subject to any co-payments, deductibles, cost sharing and benefits maximums. Generally, Medicare Part B covers cataract surgery because it's usually performed in an outpatient clinic, and most people won't require a hospital stay afterward. Yes. Filing a health insurance claim is simple and can be done in one of two ways. hb```f`` vAX,Xf000Z\ q1=nIc /( <<7C167570AC52504DB41418C8CABC0A04>]/Prev 422895/XRefStm 1266>> You can obtain an updated procedure charge schedule for your area via fax by dialing 1-800-942-0854 and using the MetLife Dental Automated Information Service. This group plan is made available to through membership in the American Association of Business Networking (ABN). endobj In addition, it comes with a concierge service (Care Advocate) and travel benefits. On average, cataract surgery costs about $5,000 per eye; however, in some places, this price can move up to over $10,000. Rates are subject to change and depend on geographic area. Dentists may submit your claims for you which means you have little or no paperwork. A class is a group of people defined in the group policy. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs.

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