Least Expensive Alternative Treatment
Least expensive alternative treatment (LEAT), also called least expensive professionally acceptable alternative treatment (LEPAAT), refers to the constraints of certain dental plans, permitting benefits only for the least expensive treatment. Under this clause, the plan will only pay for the least expensive treatment alternative, given various possible options of treatment accessible for a particular condition.
The more affordable dental plans usually offer this least expensive alternative treatment policy. Getting the least expensive treatment in a variety of treatments available is required for the policyholder who has a plan with a LEAT clause. This treatment may not be the best or may not offer long-term oral health benefits, but since the policy is low-cost compared to other plans, the treatment provided is limited.
Whereas insurance providers apply LEAT review to create benefit funding decisions under a particular plan, this application is found to be possibly confusing to patients by many dentists. Further explanations by the dentist are usually provided to clarify any confusion from the patients, especially if patients ask if their dentist’s expert judgment is being questioned by the insurance provider. The insurance providers therefore are required to educate the policyholders regarding the application of the LEAT clause when it is employed to limit benefit coverage. The limitations of this clause should be clearly understood by the plan holder and the dental patient.
The common example where LEAT clause is being applied is when composite fillings are applied as alternate to amalgams, and when crowns are applied as alternate to large fillings. The most suitable treatment decision is made by the dentist and the patient, which is usually affected by the insurance provider’s benefit funding policies based only on cost savings. Thus the least expensive treatment is applied due to the clause, but often may not be the best for the patient. The advantages and disadvantages of all treatment alternatives should be conveyed to the patient and the aspects of the proposed treatment need to be explained to avoid issues with LEAT provisions. Dentists can present a pre-estimate of the procedure cost to explain out-of-pocket costs for the consumer if necessary. Insurance providers should also make clear the benefit payments that result from application of LEAT provisions to lessen consumer confusion.
LEAT provisions are in fact one element in making dental coverage affordable. Keeping benefits within the means of the plan holders expand access to dental care. Since dental benefits has a significant role in allowing consumers to access dental care but they are paying more of the premium cost out-of-pocket as well as deductibles and co-payments, it is crucial to keep the coverage cost affordable. When a specific procedure is not covered in a dental benefit plan, the LEAT provision permits some part of the treatment cost to be paid. Here the dental plan will reimburse the allowed cost for the least expensive alternative treatment. Subsequently, the dentist is able to charge the dental patient the difference between that service and the service provided.
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