What is LEPAAT?
Least expensive professionally acceptable alternative treatment (LEPAAT), also referred to as least expensive alternative treatment (LEAT), can be a misunderstood feature of dental plan design. LEPAAT refers to the least-costly treatment alternative necessary to treat a given dental condition. When a more expensive treatment option is submitted, this may be alternative benefited to the less costly procedure, one that is also based on accepted dental practice and meets care standards.
Alternative benefits are typically applied in cases involving restorative or prosthetics. An example of this might include missing teeth in different quadrants of the same arch. In this case, the least expensive professionally-acceptable alternative treatment might be a partial denture rather than two fixed bridges. Clinical considerations are also factored in, such as serviceability of existing restorations, periodontal condition and prognosis.
Why is LEPAAT included in dental benefits?
We noted in past articles that dental plans are designed to provide financial assistance to a defined population of patients, and that, unlike more “classic” forms of insurance (ex. homeowners), patients with dental benefits are likely to use them. To ensure that they are affordable, dental plans are typically designed around low-cost, high-frequency procedures which benefit the many and emphasize prevention. Patient responsibility increases for those high-cost, low-frequency procedures (for example bridges and implants) that will impact fewer patients, but be paid for by all (through premiums).
This also goes for options within treatment classes. LEPAAT and alternative treatment provisions are administrative, not clinical, policies. They are designed to help dental plan administrators manage costs on behalf of their clients, typically employer groups, and ensure that plan premiums remain affordable for employees. LEPAAT is not a judgment on proposed treatment, nor is it meant to convey that a proposed treatment is not clinically appropriate. Dentists can offer their patients alternatives, including those that may be more expensive and may not be covered under the patient’s plan. LEPAAT defines what is covered by the patient’s contract, and is not meant to dictate what care should be provided. That decision is between the dentist and patient.
Our Recommendations
To avoid misunderstandings or unmet expectations, Delta Dental of Virginia advises being aware of plan criteria, including LEPAAT provisions, before filing a claim. Pre-determinations are also recommended whenever possible. If a filed procedure is alternative benefited, or even denied, and you wish to appeal the decision, be sure to provide additional detail in the form of radiographs, photos and/or a narrative.
Michael D Weitzner, DMD, MS
Dental Director, Delta Dental of Virginia
