Alternate benefit clause

An alternate benefit clause is a plan provision that bases payment for a service on the least expensive treatment or supplies that are effective. It is also called least expensive alternate treatment, or LEAT. NADP says the provision does not limit treatment options.

For example, a plan might pay for a silver filling even though you and your dentist chose a tooth-colored one. The plan pays its lower amount, and you pay the rest of the fee. The ADA notes that plans may acknowledge the procedure code the dentist submitted but then pay an alternate benefit.

This can change what you owe. A pre-determination can show it ahead of time. Your EOB will show how the plan processed the claim.