What are a dentist’s obligations under an “Alternate Benefit Provision” (ABP)?
An ABP is applied by insurance carriers if a dental condition can be treated by means of a professionally acceptable procedure which is less costly than the treatment recommended by the treating dentist. However, if the member and dentist choose the more expensive treatment, the member is responsible for costs beyond those allowed for the ABP. For example, an amalgam or resin restoration may be allowed in lieu of a crown. If the patient agrees to the crown treatment, a signed consent form detailing the cost responsibility of the patient should be included in his or her record.
Answer is informational only and not intended as legal advice. Answer may contain excerpts from The ADA Practical Guide to Frequently Asked Legal Questions.