Aetna Dental Insurance in Katy

How we use an Aetna dental plan

Aetna dental coverage is usually a PPO attached to a job, a spouse's job, or an individual policy. Two patients can both say "I have Aetna" and have completely different annual maximums, waiting periods, and networks. That is why we read the card instead of quoting a generic Aetna rate.

At Dentality Family Dentistry we accept Aetna dental plans and submit the claim ourselves. You do not mail forms. After we see the member ID, group number, and payer ID, we check what is left of the yearly maximum and whether a waiting period still applies to crowns, root canals, or other major treatment.

If you are new to the office, say so when you book. We can collect the Aetna member ID ahead of time, run eligibility, and walk in with an estimate instead of spending the first part of the visit on hold with the payer.

What an Aetna card usually tells us

Most Aetna dental cards are PPO cards. A PPO lets you choose your dentist and still use out-of-network benefits, though the plan pays more when the office is in the network listed on the card. Some Aetna members instead have a DMO, which is a dental HMO that only pays at assigned offices. If your card says DMO, tell us before you book so we can confirm that this office can bill it.

Preventive visits — exams, cleanings, and routine X-rays — are the part of a dental PPO that plans tend to cover most fully. Fillings and simple extractions usually fall under basic care. Crowns, bridges, dentures, and implants are major care, and many plans pay a smaller share or apply a waiting period. Aetna does not publish one set of percentages for every group, so we look up yours.

Aetna sometimes shows a medical plan and a dental plan on different cards that share a logo. We bill only the dental payer. Bringing both cards is still useful, because the member ID on the medical card is not always the one dental claims use.

Bring this to your visit

A clear photo is enough if you do not want to hand over the physical card. We copy the ID, the group, and the claims address or electronic payer ID from that photo before you sit down.

• A photo of the front and back of the Aetna dental card, not only the medical card
• The name of the subscriber if the plan is through a spouse or parent
• Any recent treatment you had under this plan, so we do not double-count the annual maximum
• A list of questions about a specific tooth, if you already know what you want checked

After the claim is filed

We send the claim electronically and keep a record of the submission. Aetna then sends an explanation of benefits to you and a payment to the office according to the plan. If Aetna asks for an X-ray or a narrative before it pays a crown or a periodontal procedure, we respond to that request. You should not have to chase the carrier yourself.

If the estimate shows a balance, we will say so before treatment starts. Patients who want to spread a larger balance out can ask about financing or the in-house membership plan. Details for every carrier we accept are on the insurance and financing page.

Keep the explanation of benefits when it arrives. If the allowed amount is lower than the estimate, bring that statement back and we will compare it with what we sent Aetna rather than asking you to sort it out alone.