Alternate Benefit Clause. Who does it help?

We get asked so many times - "why does my insurance not pay 50% like my policy states?" Unfortunately, the insurance companies have come up with a method that allows them to change the code of the service your received to a lesser quality service code. They then apply any outstanding deductibles and then apply their applicable percentage (for example - 50% is standard for most crowns). This will then let them pay 50%, but on a lesser fee. Then the patient has to pay any outstanding deductible AND the 50% PLUS the difference between the service actually received and the fee that the insurance company changed it to. Confusing? Yes, and this is only one of the things they do to keep more of your money. 

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