Out-of-Network Service
Occasionally, a Member may want to seek care from an Out-of-Network dentist. The MILA Dental Plan provides coverage for Out-of-Network dental service. However, there are significant reasons why Members generally should use participating network providers.
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Dentists who participate in the Network have been credentialed by Aetna and their services are regularly reviewed to ensure high quality and conformity with standards set by the American Dental Association.
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The MILA Dental Plan reimburses all dentists based on fees that have been negotiated with network dentists and are substantially discounted over the fees regularly charged by dentists in their geographic area and dental specialty of practice. Many Out-of-Network dentists will charge more than this negotiated fee.
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Not only will the Member pay the Plan deductible and coinsurance as a percentage of the negotiated fee; he/she also will be responsible for any charge made by the Out-of-Network dentist in excess of the negotiated fee.
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It is particularly important to secure Pre-Treatment Estimates for work that will be performed by Out-of-Network dentists. This will allow the Member to understand what his/her costs will be before the work is done and will permit the Member to negotiate that cost if the Member desires.
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In the case of a true dental emergency, the Plan will cover the necessary emergency service as if it were rendered In-Network regardless of whether the provider is a Network provider.
Note
One should attempt to use Network providers whenever possible in order to be assured of receiving the highest quality of dental service at the lowest possible total cost to you and your family.
