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Understanding Alternate Benefit Provision
The Alternate Benefit Provision helps determine
how payment will be made when there are two or more
clinically acceptable dental services available to satisfactorily
correct the same dental condition. This provision states that
United Concordia will provide coverage for the less expensive
service available, while still ensuring that you receive
the quality care you need for a healthy smile.
Example 1: If you need a filling for any of
your back molars, you would pay the applicable deductible and
copayment, and United Concordia would pay the remainder up to
the allowance for the amalgam (silver-colored)
filling. If you and your dentist choose to use a composite
resin (tooth-colored) filling, the program
would still cover up to the allowance for the amalgam filling
(alternate benefit) and you would be responsible for
paying your dentist the difference in cost between the
amalgam and the composite resin fillings.
Example 2: Often a cracked tooth can be
repaired using a four-surface filling. If you and your
dentist decided to use a crown, the plan would pay its share
of the allowance for the four-surface filling and you would
be responsible for paying the difference.
It's important to discuss all of your options with your dentist
prior to treatment. If a proposed treatment plan is estimated
to cost $500 or more, United Concordia encourages you to
ask for a predetermination. Your dentist will submit the
information to United Concordia and you will receive an estimated
breakdown of how much the plan covers and how much you will have to pay,
helping you make the most of your dental plan.
Other Benefits Briefs
Understanding
Coverage for Fillings
Understanding
Coordination of Benefits
About
United Concordia's Network
We also have a library of Dental
Health 101 articles for you and your employees' information. Please feel
free to use these in your publications/communications as well.
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