Aetna Member Story
Bridging Smiles For Emma
Emma*, a 4-year-old experiencing chronic dental pain, was in urgent need of oral surgery under general anesthesia due to the complexity of the required procedures. However, no in-network providers within 120 miles could accommodate her. Her family and DentaQuest’s provider search had reached a standstill.
ACM Ashley Boyles initiated an out-of-network search with DentaQuest and escalated the case to leadership. Although a provider was found an hour away, Andrea continued advocating for a more convenient and familiar option due to Emma’s young age. She identified a local dental office that had treated Emma previously and submitted the information to DentaQuest, who successfully engaged the provider in a single case agreement (SCA).
During planning, it became clear that a separate SCA was also required for anesthesia services. RN Case Manager Carla Mendoza collaborated with utilization management, contracting, and the DentaQuest team to finalize agreements with both the dental and anesthesiology providers.
The SCAs were approved, and Emma was scheduled for oral surgery with access to general anesthesia - providing much-needed relief and care close to home.
*Member name changed to protect privacy
