0000014887 00000 n Help Center Bigger. This assures State of Delaware Aetna and Highmark Delaware members will have access to surgeons and facilities that meet strict SurgeryPlus credentialing guidelines, leading to the highest quality care possible. Home health services, Medicare.gov, last accessed June 10, 2022. Many Medicare Advantage plans also provide prescription drug coverage (also known as Part D).5, Original Medicare does not include coverage for prescription drugs, but you can buy a stand-alone prescription drug plan to help manage your drug costs. The specific travel benefit depends on the procedure, the provider, and the distance between the provider and a member's residence. You consent to receiving palliative care to make you comfortable versus care to try to cure your illness. Medicare Part B (medical insurance) helps cover the cost of medically necessary durable medical equipment if your doctor prescribes it for use in your home. Transparency Copyright 2023 Member Benefits. Dentists may submit your claims for you which means you have little or no paperwork. You can track your claims online and even receive e-mail alerts when a claim has been processed. RSS Feeds, Make 0000001609 00000 n The inclusion of a code does not imply any right to . You can obtain an updated procedure charge schedule for your area via fax by dialing 1-800-942-0854 and using the MetLife Dental Automated Information Service. 2 If you have Medicare Part B primary, your costs for prescription drugs may be lower. Delaware State Code h`06NH+500 General Assembly We will not exclude payment of benefits for such services if the government plan requires that Dental Insurance under the group policy be paid first; Duplicate prosthetic devices or appliances; Replacement of a lost or stolen appliance, Cast Restoration, or Denture; and. This may include surgery to remove cataracts or after an eye injury. You can choose whether or not to use SurgeryPlus for your surgical procedures. "_P^)J^:+&!nI-eMNYrVY;QU&+,SUdTVvSN(GTDS o5q_H\%lqbF$M2Q::=x?c}Efl 2"PwyOP# 3V&$b$E7TXI!"?k* NZOLizJT5A7a Xk56C*I~EOv {)Z` YFJ#i'O>4@6.\7=dBkwR)K@kJ^.|xs-v(\irQJhpQ-[":wwT%9KBU2hNU^ 6/En!`}#Yrud9,/R We cover the most expensive costs associated with your surgery so youll pay less for your procedure. Generally, most vision, dental and hearing services are not covered by Medicare Parts A and B. Effective July 1, 2023, bariatric surgery coverage will be available exclusively through the SurgeryPlus benefit. Hospice care, Medicare.gov, last accessed June 10, 2022. Click Register Now to create your profile and start exploring this free service. You can make monthly payments by monthly bank draft (ACH) or pay for the entire year via credit card payment. An explanation of whats not covered and/or the limits on coverage, Information on costs you might have to pay like deductibles, coinsurance and copayments, Coverage examples, including how coverage works in the case of a pregnancy or a minor injury. Pre-authorization will still need to be submitted by your provider to SurgeryPlus before the surgery is scheduled. There are no simple answers, but you can start here to find general answers to some of the most common questions about Medicare coverage. Filing a health claim. A participating dentist is a general dentist or specialist who has agreed to accept negotiated fees as payment in full for services provided to plan members. Facilitate and consolidate your payments. Expand your practice We route you incremental cases outside the typical radius of your practice. Please fill out the contact form so the right person can be in touch quickly. International dental travel assistance services are administered by AXA Assistance USA, Inc. AXA Assistance is not affiliated with MetLife or any of its affiliates, and the services they provide are separate from the benefits provided by MetLife. Actual payments may vary from the pretreatment estimate depending upon annual maximums, plan frequency limits, deductibles and other limits applicable at time of payment. cost of cataract surgery with medicare. You can also go through the SurgeryPlus member portal. 0000015692 00000 n endstream endobj 124 0 obj <>/Filter/FlateDecode/Index[5 84]/Length 22/Size 89/Type/XRef/W[1 1 1]>>stream Many offer affordable or even $0 monthly plan premiums, but you must continue to pay the Medicare Part B premium. Mon-Fri, 8:30am-5:00pm (ET), Texas office If it contains a form, you can print it and fill it out. For procedures requiring inpatient admission or overnight recovery, the travel benefit covers the patient and one companion for a limited amount of time. They help you find a great doctor for your procedure, schedule your procedure appointments, make travel reservations (if travel is required), transfer your medical records, and coordinate all your surgery bills. 0000024943 00000 n Continuous Glucose Monitors (CGMs)examples include Dexcom and Libre. Out-of-pocket costs may be greater if you visit a dentist who does not participate in the network. At time of enrollment, you will choose how you want to pay. Every SBC is created with four double-sided pages and 12-point type. Fair and simple terms We pay a fair, transparent rate for cases and streamline reimbursement, decreasing your administrative burden. Confirm your coverage before you commit to a procedure you're unsure about. Procedures can cost from $700 to $2,000 per eye, depending on . 1. The cost of cataract surgery not only depends on the equipment used and the IOL implanted, but on the skill of the surgeon, your overall health, and where you live in the country. <>stream There is a long list of items covered, including: Before renting or purchasing any medical equipment, be sure to ask if the retailer or supplier participates in Medicare. This symbol denotes a Web Page. HIP Plus is the plan for the best value.HIP Plus provides health coverage for a low, predictable monthly cost. Like most group benefit programs, benefit programs offered by MetLife and its affiliates contain certain exclusions, exceptions, reductions, limitations, waiting periods and terms for keeping them in force. Each company is a separate entity and is not responsible for another's financial or contractual obligations. 10739 Deerwood Park Blvd, Suite 200-B It also doesnt cover help for whats called activities of daily living, like bathing, getting dressed, using the toilet, eating or moving from place to place within your home.9. This type of surgery is only used for people who are very overweight and have not been able to lose weight with diet and exercise. This document presents the majority of services within each category, but is not a complete description of the plan. Actual payments may vary depending upon plan maximums, deductibles, frequency limits and other conditions at time of payment. This assures State of Delaware Aetna and Highmark Delaware members will have access to surgeons and facilities that meet strict SurgeryPlus credentialing guidelines, leading to the highest quality care possible. Trust in our network 0000001651 00000 n If you qualify for it, Medicaid, which is administered by states under federal guidelines, may cover nursing home care. There are thousands of PDP Plus Network general dentists and specialists to choose from nationwide so you are sure to find one who meets your needs. Learn more aboutsavings and spending accounts. Medically necessary services diagnose and treat health problems. Please use this access code on website: surgeryplus. 866-855-1212. such as Spine, General Surgery, Genitourinary, Orthopedic, Ear, Nose & Throat, Cardiac, GI, and Pain Management. 0000009101 00000 n American Airlines manages employee and retiree health benefits. Benefit coverage for health services is determined by the member specific benefit plan document and applicable laws that may require coverage for a specific service. The SurgeryPlus Difference We allow you to focus on practicing medicine and caring for patients. Coverage Policy ; Coverage for bariatric surgery or revision of a bariatric surgical procedure varies across plans and may be governed by state mandates. You and your dentist will each receive an Explanation of Benefits (EOB) outlining the services provided, your plans reimbursement for those services, and your out-of-pocket expense. But treatment for chronic eye conditions like cataracts or glaucoma may be covered if your doctor considers it to be medically necessary.12. Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs.". 0000005131 00000 n Mastectomy surgery is a significant life event for many people. This symbol denotes a PDF Document. Your general dentist or specialist usually sends MetLife a plan for your care and requests an estimate of benefits. Benefits are subject to change upon agreement between Metropolitan Life Insurance Company and the participating organization. You can search a list of these participating dentists online or call 1-800-942-0854 to have a list faxed or mailed to you. The sharing of health information between these companies is permitted by regulation. 0000005180 00000 n Alternatively, a Medicare Advantage plan often provides comprehensive vision coverage, plus cataract surgery without out-of-pocket coinsurance costs." Medicare pays 80% of the cost of traditional cataract surgery, which would be covered by Medicare Part B. Please refer to your Evidence of Coverage or call Customer Service at the number on the back of your Humana ID card to confirm that the service will be covered by your plan. Find out which Humana plans include your doctors and cover the medications you take now to help you estimate your costs. SurgeryPlus Frequently Asked Questions General Questions . It all depends on your policy. Assign you a personal care coordinator to offer one-on-one guidance and support as you prepare for, undergo and recover from surgery. <> The documentation requirements outlined below are used to assess whether the member meets the clinical criteria for coverage but do not guarantee coverage of the service requested. Outpatient: 15% of our allowance . Inpatient hospital: $450 per admission copay for unlimited days, plus 35% of our allowance. Negotiated fees typically range from 15-45% below the average fees charged in a dentists community for the same or substantially similar services. }4Q2L_L 0fI\l!AN7za|*_)2:lU2_kciTX*R:N%` c8B=3 1 Under Basic Option you pay 30% of our allowance for agents, drugs and/or supplies you receive during your care. Once your policy takes effect, you can still add or remove dependents to your coverage once per year on the group plan anniversary date of Jan 1 or if you have a qualifying event such as marriage, divorce, birth of a child, and spouses termination of employment. Members will pay nothing out of pocket for bariatric surgery; however, financial incentives do not apply. These partners are required to comply with all laws protecting privacy. Please review the plan summaries for summarized information and your certificate of insurance for detailed information about your plan benefits. This is because you won't know what services you need until you meet with your provider. Complete and submit the form and well be in touch soon. Procedure charge schedules are subject to change each plan year. The time a mother and baby spend in the hospital after delivery is a medical decision. State Employees Consult your healthcare provider if you have questions or concerns. A prime example is breast implants done during or after breast cancer surgery. Your medical insurance may also pick up the cost in full or part for medically-related . 273 0 obj <>/Filter/FlateDecode/ID[<0FC6C6833B2C26439F46B854E028A8C8>]/Index[250 36]/Info 249 0 R/Length 110/Prev 207371/Root 251 0 R/Size 286/Type/XRef/W[1 3 1]>>stream Rates are subject to change and depend on geographic area. This is a voluntary benefit available to you if you're enrolled in the Core, Standard, Plus or High Cost Coverage medical option. %%EOF 0000418667 00000 n Public Meetings Coverage may not be available in all states. 285 0 obj <>stream endstream Consistent with federal law effective 1/1/98, the Cigna national maternity policy includes coverage for 48 hours of hospitalization following a normal vaginal delivery and 96 hours following an uncomplicated Caesarean section. For specific LCDs/LCAs, refer to the table for An estimated cost of cataract surgery may be*: In a surgery center or clinic, the average total cost is $977. Inpatient (Precertification is required): $350 per admission. Individuals enrolled in a State of Delaware Aetna or Highmark Delaware non-Medicare health plan are automatically enrolled in this FREE benefit. Medicare pays 80% of the treatment costs, and the beneficiary contributes 20%. Pick the option that's best for you. 0000011564 00000 n Withholding Tax When you already have a health plan, youll get an SBC automatically at certain times: Even though an SBC is made to make it easier to understand health plan information, sometimes the terms in them can be confusing.