
2024 Ambetter Provider Network Highlights
2024 Ambetter Provider Finder
2024 Ambetter Provider Finder
Service | In-Network | Out-of-network |
---|---|---|
Routine Eye Exam
|
100% Covered | Not Covered |
Eyeglasses (frames)
|
Covered up to $130 | Not Covered |
Lenses (per pair)
|
100% Covered | Not Covered |
Contact Lenses (in lieu of glasses)
|
Covered up to $130 | Not Covered |
Preventative and Diagnostic (Class 1) | In-Network | Out-of-network |
---|---|---|
Routine Cleaning
|
No Charge | Not Covered |
Oral Exam
|
No Charge | Not Covered |
X-Ray ? bite ? wing, full-mouth and panoramic film
|
No Charge | Not Covered |
Minor Restorative (Class 2) | In-Network | Out-of-network |
---|---|---|
Minor Restorative ? metal and resin-based fillings
|
50% Coinsurance | Not Covered |
Endodontic Therapy
|
50% Coinsurance | Not Covered |
Periodontics ? scaling, root planning, and
periodontal maintenance |
50% Coinsurance | Not Covered |
Simple Extractions
|
50% Coinsurance | Not Covered |
Prosthodontics ? relines, rebase, adjustment,
and repairs |
50% Coinsurance | Not Covered |
Major Restorative (Class 3) | In-Network | Out-of-network |
---|---|---|
Crowns and Bridges
|
50% Coinsurance | Not Covered |
Dentures
|
50% Coinsurance | Not Covered |
More Complex extractions and surgical services
|
50% Coinsurance | Not Covered |
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