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Our Dental-Medical Integration Program

At risk members are automatically identified and encouraged to visit a dentist

We want to educate our members about the importance and value of dental care as part of the overall treatment of their medical conditions, so they'll be encouraged to visit their dentist regularly. Aetna member claims data automatically triggers our Dental Medical Integration (DMI) Program.

It's seamless. Since we have both medical and dental claim information, we can see who's at risk. Our DMI Program focuses on members who are pregnant, or have diabetes, heart disease and/or cerebrovascular disease. Enrollment for these members is automatic. There is no extra paperwork to complete by dentists or our members.

Educational materials and a dental care coordinator are offered

We reach out to at-risk members who have not gone to the dentist in the last 12 months. These members will get educational material explaining the link between periodontal disease and their health condition. We urge them to call our dental care coordinators to:

  • Choose a dentist or
  • Get help making a dental appointment

If a member does not visit a dentist after receiving our educational material, our dental care coordinators will follow up.

Enhanced benefits complete the program

The program also offers the at-risk member enhanced benefits. These benefits are covered in full with no deductible:

  • One extra visit for a routine prophylaxis
  • Full mouth debridement
  • Scaling and root planing
  • Periodontal maintenance
  • Localized delivery of antimicrobial agents (not included for pregnant women due to contraindications)

The payment for these services is automatic as our system knows if a member is enrolled in the DMI Program.