How do I find my Aetna fee schedule?
How to access your fee schedule
- If you’re affiliated with an Independent Practice Association (IPA), contact your IPA for a copy of your fee schedule.
- If you’re directly contracted with Aetna, you can call our Provider Service Center for help with up to ten Current Procedural Terminology® (CPT®) codes.
What is DMO dental plan?
A DMO is a network of dentists and specialists who provide dental care services at a fixed cost. With the DMO, a participant does not have to meet a deductible or file any claim forms. The Aetna DMO is available only in areas where there are participating dentists.
How much does Aetna dental insurance cost?
Aetna Dental Plans and Pricing
| Plan | Type | Cost (Individual/ Family) |
|---|---|---|
| Aetna Dental® Direct Core | PPO | $51-64/$99-120 *varies by location, estimates calculated for one or two adults between ages 50 and 60. |
| Aetna Vital Dental Savings | Discount Card | $7.99/$10.99 |
| Aetna Vital Dental Savings Plus Rx | Discount Card | $9.99/$12.99 |
Does Aetna have a fee schedule?
Contracted physicians can access fee schedules online on our secure provider website. * Fees displayed are based on contracted amounts negotiated for specified treatments. They reflect the amounts allowed for services as if Aetna is paying each ASNCPT/HCPCS code on a line-by-line, fee-for-service basis.
What is an insurance fee schedule?
Fee Schedule — a cost containment tool utilized in workers compensation to standardize and avoid excessive medical costs associated with claims. Fee schedules are published by most states and set down the maximum charges for various medical procedures.
How do I get a fee schedule for availity?
Access the fee schedules app In the Availity Portal menu, click Claims & Payments > Fee Schedule Listing. On the Fee Schedules page, click Fee Schedules. Note: Hover over the View Payers icon to review the associated payers for your organization.
What is a DMO dental plan in Virginia?
Virginia Members: In Virginia, DMO is called DNO (Dental Network Only). DNO (Dental Network Only) in Virginia is not an HMO. To receive maximum benefits, members must choose a participating primary care dentist to coordinate their care with in-network providers.
How does the DMO plan work for Aetna?
Aetna has an arrangement with our DMO providers that sets what they can charge for covered services. What you pay will be based on either a percentage of those charges (coinsurance) or it will be a flat dollar amount (copay). The DMO plan does not have any deductibles or annual maximums.
How does the fee schedule work for Aetna?
They reflect the amounts allowed for services as if Aetna is paying each ASNCPT/HCPCS code on a line-by-line, fee-for-service basis. Note that physician fee schedule information will not display accurate rates for care services provided to Aetna members who participate in an accountable care organization {ACO) arrangement.
How is dental reimbursement determined on an Aetna plan?
Dentist’s reimbursement is a combination of what Aetna pays the dentist and the member’s copay/coinsurance amount. How are the co-payments or coinsurance determined for each service?
How do I get an insurance fee schedule?
You can call the provider representative at the insurance company (payer) and ask them to fax you a copy of your contract with an updated fee schedule. Go to the provider section on the insurance company’s website, and download a copy of the fee schedule.
What is a PPO fee schedule?
A fee schedule is a complete listing of fees used by Medicare to pay doctors or other providers/suppliers. This comprehensive listing of fee maximums is used to reimburse a physician and/or other providers on a fee-for-service basis.
Does Aetna reimburse for therapy?
As long as your treatment is in-network, Aetna will cover it.
How do you negotiate insurance fee schedules?
5 tips to negotiate favorable payer contracts
- Focus on payers that consistently pay below the Medicare fee schedule amount.
- Create a value proposition.
- At a minimum, ask for a cost-of-living increase.
- Don’t forget ancillary services.
- Involve your coders.
What is a dual fee schedule?
What is a Dual Fee Schedule? Simply put, it means charging more to an insurance company or a third-party payer than you do to a cash patient for the same services.
What is the schedule fee?
The Schedule fee is the amount the Government considers appropriate for one of these services. Health consumers can claim 100% of this fee as a rebate for general practice services and 85% of non-GP services from Medicare when the services are provided out of hospital.
What are some types of fee schedules?
In general, there are typically three levels of fee schedules: Medicare, Medicaid, and Commercial. The different levels of fee schedules offer varying levels of payment rates to the physician and are determined separately by the various involved parties.
How much does therapy cost Aetna?
If you choose a therapist who is in-network with Aetna, your therapy sessions likely cost between $15 – $50 per session, after you meet your deductible. The $15 – $50 amount is your copay, or the fixed amount that you owe at each therapy visit.
What kind of chiropractic services does Aetna offer?
Aetna considers the following chiropractic procedures experimental and investigational: Active Release Technique (see CPB 0388 – Complementary and Alternative Medicine) Active Therapeutic Movement (ATM2)
What do you need to know about Aetna better health?
Aetna Better Health covers customized wheelchairs for children and adults as listed in the DME and Medical Supply Services Coverage and Limitations Handbook, pages 2-91 through 2-96, and the DME and Medical Supply Services Fee Schedule, including all accompanying parts needed to operate the equipment. Prior authorization is required.
How does the Aetna provider cost estimator work?
Our provider cost estimator tool helps your office estimate how much your patients will owe for an office visit or procedure. And it approximates how much Aetna will pay for services. Plus, you can use it prior to a patient’s scheduled appointment or procedure.