Least Expensive Alternative Treatment
Also written as: LEAT — Least Expensive Alternative Treatment
An insurance policy provision under which a plan pays only for the least costly clinically acceptable procedure when multiple treatment options exist.
Full Definition
The Least Expensive Alternative Treatment (LEAT) clause, also called 'least expensive professionally acceptable alternative' by some payers, allows an insurer to limit reimbursement to the fee for a less costly procedure if it would achieve an equivalent clinical outcome. For example, if a patient chooses a porcelain crown over a stainless-steel crown, the insurer may pay only the allowance for the less expensive option. Editors working on patient financial documents, benefit summaries, or claim denial letters must render this phrase consistently and distinguish it from downcoding, which involves altering the procedure code itself. LEAT clauses are particularly common in paediatric and restorative dentistry sections of benefit booklets.
Usage
Usage note: Acronym LEAT is acceptable after first use. Do not confuse with 'downcoding', which changes the submitted code; LEAT pays a lower benefit without altering the code.
In Context
- "The EOB explanation cited the least expensive alternative treatment provision as the reason for the reduced payment on the all-ceramic crown claim." — Explanation of Benefits document
- "Editors should spell out 'Least Expensive Alternative Treatment' in full on first use, then use the acronym LEAT thereafter." — Editorial style guide for insurance documents