Procedures & Codes
Benefits Overview
Plan Types
Benefit Explanation
Wild Card
100
01110
What is the procedure code for an adult cleaning
100
Should be used on every call to explain how benefits are covered
What is general breakdown
100
Negotiated fees for providers in the MetLife's Prefered Dental Program. Rates that are average for a geographic area and are usually charged.
What is R&C
100
Date individual and/or dependents become eligible for benefits under dental benefit contract.
What is effective date
100
Dental Service Auto & Home Service General Agency Underwriting Auto & Home Sales
What are some departments located in the Dayton office
200
3310,3320 & 3320
What are procedure codes for root canals
200
Payment method (Schedule, R&C (%), negotiated fee, or Hybrid (% and fee schedule) Deductible Maximum Frequency Limitations (some plans) Alternate Benefit may be applied (check plan and tooth #)
What is the general breakdown for a filling or crown
200
Where some of the services are covered on a percentage of R&C and some are covered under a scheduled amount.
What is a hybrid plan
200
Written statement to beneficiary from third-party payer after claim has been reported, indicating benefit/charges covered or not covered by dental benefit plan, and may include various notes regarding any adjustments made to the payment or reasons for any denial.
What is an EOB (Explanation of Benefits)
200
Pat Wessel Amanda Powell Kathy Linville Steve Kandarian
What is the names of Leadership at MetLife
300
Removing the diseased nerve tissue from within the tooth, cleaning and shaping the nerve chamber and filling the pulpal space.
What is a root canal
300
Fast Fax IVR Website
What options callers have to recieve plan information
300
A prepaid dental service plan when providers join a carrier's network in exchange for a capitation payment
What is DHMO
300
Deductible that is satisfied by combined expenses of all covered family members. For example, a program with $25 deductible may limit its application to a maximum of three deductibles, or $75 for the family, regardless of number of family members.
What is Family Deductible
300
Put Customers First Be the Best Make Things Easier Succeed Together
What are MetLife's Core Values
400
Is usually considered to be part of Removable Prosthodontic procedures.
What is anesthesia
400
Effective Date of member's dental coverage % (percentage) in and out of network (when applicable) or advise method of payment (Fee Schedule, Co-Pay, etc.) NOTE: When providing benefits to EE/Dependent and mentioning the PDP fee add the wording unless additional charges are permitted by state law Deductible and Maximum and what will each applies to If Ortho is needed, also include Method of Payment (e.g., Monthly, Lump Sum, etc.) Advise procedures may be subject to review and suggest pretreatment estimate Required Scripting: "Please note, the plan has certain limitations and/or guidelines. Certain procedures may be subject to review, we suggest a pre-treatment estimate" If applicable, advise if last FMX (full mouth xray) includes bitewing xrays it could affect bitewing frequency limitation
What is the short checklist
400
Customer does the administration (Marketing, Enrollments, Certificates, Billing) MetLife does the claim processing. Cost of coverage is paid for by the Enrollee - The Employer Group does not make any contributions. One of the benefits of this coverage is that the cost is discounted at the Group Rate.
What is a voluntary plan
400
Restrictive conditions stated in dental benefit contract, such as age, length of time covered, and waiting periods, that affect individual or group coverage.
What are Limitations
400
La Kishia Thomas
What is the person that has taught me the most about MetLife! AKA "The Best Trainer I Have EVER had"!
500
Never developed tooth(teeth). May apply to either adult or primary (baby) teeth
What is Congenitally Missing Teeth
500
Date of RCT or re-treatment canal is required for processing Post & Core (2952, 2953, 2954 and 2957) ·Not subject to review unless submitted in conjunction with other services that are subject to review or if indicated on plan media ·Procedure is subject to plan frequency limitations
What is the general breakdown for post and core
500
A plan that determines the allowable charge based on the negotiated schedule for the provider's zip code whether a participating provider is used or not.
What is a MAC Plan
500
Veneer Crowns: The plan will not pay for a Veneer Crown, but MetLife will consider payment for benefits equal to an Acrylic Veneer in its place. Porcelain Crowns: The plan will not pay for a Porcelain Crown on a bicuspid (pre-molar), but MetLife will consider payment for benefits equal to a resin crown in its place.
What is Narrative 76
500
3920
What is the procedure code for Hemisection
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