Insurance and billing
Alternate benefit clause
Also called downgrade, least expensive alternative treatment, LEAT
A plan rule where the insurer pays based on a cheaper treatment option even if the patient chooses a costlier one.
Under an alternate benefit clause, the plan may base its payment on the least costly acceptable treatment rather than the one chosen. A common example is a tooth-colored filling on a back tooth, where the plan pays at the silver filling rate and the patient covers the rest. This is sometimes called a downgrade. Explain it in the estimate so patients know the difference is theirs to pay.
Example at the front desk
The plan will pay only the amalgam amount for the white filling, so your share is higher.