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Understanding Aetna Oral Surgery Benefits

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.How do I determine if a procedure is a Medical or Dental expense?.
.I participate in your dental but not your medical networks; how will I be reimbursed if the procedure is covered under Aetna medical?.
.I participate in your dental and medical networks; how will I be reimbursed?.
.Are referrals required for oral surgery services covered under Aetna medical?.
.Do oral surgery services require clinical review?.
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Aetna Has Teams Dedicated To Help Your Office With Oral Surgery Claims and Questions
Offering an Oral Surgery Center and specialized Oral and Maxillofacial Surgery Patient Management team are two ways we make doing business with us easier. The Oral Surgery Center is a specialized team equipped to handle all variations of oral surgery claims, including dental and medical.

The Oral and Maxillofacial Surgery Patient Management team consists of board-certified oral and maxillofacial surgeons and nurses who are dedicated to the clinical review of certain surgical requests. In addition, this team provides precertification for oral and maxillofacial surgery and related services in accordance with the Aetna Medical Clinical Policy Bulletins.

To help make Aetna oral surgery benefits easier to administer, below are answers to some common questions.

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How do I determine if a procedure is a Medical or Dental expense?
Step 1:

Determine if the procedure is classified as Dental in Nature (DIN) or Medical in Nature (MIN).

Click on these links to find a list of DIN procedures and MIN procedures.

Step 2:

Determine in what Aetna plans your patient is enrolled.

Step 3:

Refer to this chart to determine if the procedure is covered and, if so, whether it is a medical expense or a dental expense.

The chart represents information for standard Aetna plans.

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I participate in your dental but not your medical networks; how will I be reimbursed if the procedure is covered under Aetna medical?
Your dental rate will always be used to reimburse oral surgery services.

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I participate in your dental and medical networks; how will I be reimbursed?
Your dental rate will be used for reimbursement when the procedure is covered under dental and your medical rate will be used when the procedure is covered under medical.

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Are referrals required for oral surgery services covered under Aetna medical?
No. Please refer to the Dental Office Guide for Dental DMO protocols.

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Do oral surgery services require clinical review?
Yes, some may. Please refer to the claim attachment guidelines for details on required diagnostics.

Member plan designs may vary and coverage is subject to the specific member's plan.

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