Aetna dental members have two common questions for us: are you in-network, and does that include my Medicare Advantage plan? The answer to both is yes, at both offices. Here are the details.
Which Aetna plans we are in-network with
Kokopelli Family and Cosmetic Dentistry in Ahwatukee and Kokopelli Dentistry of Chandler are both in-network with Aetna Dental PPO and with Aetna Medicare Advantage dental plans, through direct contracts with Aetna.
The Medicare Advantage part matters. Many dental offices participate in Aetna's commercial PPO but not in the dental benefit that comes with Aetna Medicare Advantage medical plans. We chose to contract directly so that patients on those plans, and there are many in the Chandler area, could keep in-network pricing with us.
What in-network with Aetna means for your bill
Aetna sets a contracted fee for each procedure with in-network dentists. That fee is the most we can charge you. Aetna pays its share, and you pay the rest.
Aetna PPO plans generally cover preventive care at a high percentage, fillings and similar work at a middle percentage, and crowns, implants, and other major work at a lower percentage after a deductible. Aetna Medicare Advantage dental benefits vary quite a bit by plan. Some cover preventive care only, and some include an allowance for restorative work. We look up your specific plan before your visit and give you a written estimate before any treatment.
Your first visit as an Aetna patient
Call whichever office is closer with your Aetna member ID. For Medicare Advantage plans, your medical card is usually the one we need. We verify your dental benefits before you arrive.
The first visit is a full exam by Dr. Kaur or Dr. Thompson at Ahwatukee, or Dr. Kaur at Chandler, the X-rays we need, and a cleaning when your gums are ready for a regular one. If you need treatment, you get an estimate that shows the Aetna fee, what Aetna is expected to pay, and your share. Nothing beyond the exam happens without your go-ahead.
Tips for Aetna members
Know your plan year and annual maximum. They drive how we schedule larger treatment.
Use your preventive benefits. They are usually the best-covered part of the plan.
For Medicare Advantage members, ask us to check your plan's dental allowance early in the year. Some allowances are use-it-or-lose-it, and it is better to plan a crown in March than scramble in December.
Ask for a pre-treatment estimate on major work. Aetna will confirm what they expect to pay.
A note for people new to Medicare Advantage dental
Dental coverage in a Medicare Advantage plan works differently from an employer PPO, and the differences trip people up. Some plans give you a set dollar allowance for the year and let you spend it on almost anything. Others cover preventive visits fully but pay a fixed percentage of other work. A few cover only cleanings and exams. Most require you to use an in-network dentist to get the benefit at all, which is the part that matters most when you are choosing where to go.
When you call, tell us the name of your Aetna Medicare plan as it appears on your card. We will pull up the dental portion, explain it in plain language, and tell you what your first visit is likely to cost you before you come in. If the answer is nothing, we will tell you that too.
Frequently asked questions
Do you take Aetna Medicare Advantage at both offices?
Yes. Both Ahwatukee and Chandler are in-network for Aetna Medicare Advantage dental benefits.
Do you take Aetna DMO?
No. Aetna DMO is a managed-care plan that assigns you to one office, and we are not a DMO office. If your card says DMO, call us and we will explain your options.
Does Aetna cover implants or dentures?
Many Aetna PPO plans cover part of the cost of implants, crowns, and dentures as major services, subject to your annual maximum. Medicare Advantage plans vary. We check before you decide. You can read about dental implants and dentures on our site.
Are both dentists in-network with Aetna?
Yes. Dr. Kaur and Dr. Thompson are both on our Aetna contracts. Dr. Thompson sees patients at Ahwatukee; Dr. Kaur sees patients at both offices.
Next step
Ahwatukee, call Kokopelli Family and Cosmetic Dentistry at (480) 283-0733. Chandler, call Kokopelli Dentistry of Chandler at (480) 895-3252. Have your Aetna card ready and we will verify your benefits before your first visit.
Disclaimer: This article is general information from Dr. Harveer Kaur and is not a substitute for a dental exam, diagnosis, or treatment. Every mouth is different. If you have a concern about your teeth or gums, call our Ahwatukee office at (480) 283-0733 or our Chandler office at (480) 895-3252 and we will help you sort it out.
Dr. Harveer Kaur, DDS, BDS
Dr. Kaur is the founder of Kokopelli Dentistry, serving patients in Ahwatukee and Chandler, Arizona. She focuses on family and cosmetic dentistry.
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