How Does the Aetna Dental Maintenance Organization Work?


Quick Answer

The Aetna Dental Maintenance Organization blends coordinated primary dental care with a broad range of other dental services. Members choose a participating primary care dentist and pay for services via co-insurance or co-pay. Dentists generally submit claims on the patient's behalf, and there is no deductible or annual benefit cap.

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How Does the Aetna Dental Maintenance Organization Work?
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Full Answer

Eligible DMO members receive preventative, basic and major dental services from primary care dentists within the DMO network. If the patient chooses to seek primary care from a non-participating dentist or sees a specialist without a referral from a participating dentist, he faces the possibility of having to pay the entire cost out of pocket. Referrals are only necessary for specialty care and are not required for orthodontia as long as orthodontia is covered by the patient's plan. When the patient does need a referral or pre-authorization, it is available at no cost to the patient.

A Dental Maintenance Organization is a lower-cost alternative to a Preferred Provider Organization plan. DMO members are not required to pay out-of-pocket costs like PPO members. Fixed co-insurance and co-pay also keep costs low for patients. Through Aetna's DMO Access plan, patients can save even more by receiving care from dentists in the discount dental network.

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