What are the requirements for a dependent child to see a Pediatric dentist?
Pediatric dentists are specialists, but the Primary Care Dentist may directly refer to a participating Specialty dentist for consultation or problem focused examination for children under age 6 if (a) the Primary dentist has documented at least one unsuccessful attempt to treat the child, and (b) at least one of the following conditions is present. The child has an existing medical condition or is developmentally disabled; presents a behavioral management problem; has rampant carries; or requires emergency care that is beyond the scope or ability of the primary care dentist. All other conditions or procedures not indicated must be preauthorized by Aetna. This includes referrals for children age 6 or older with a medical condition, significant behavioral management problem and severe caries that may require referral to a Specialty Dentist. Until the referral is authorized, only the consultation will be covered.
