What is an Alternate Benefit and how does it work?
If MetLife determines that a less costly covered service other than the covered service the dentist performed, could have been performed to treat a dental condition, we will pay benefits based upon the less costly service if such services would produce a professionally acceptable result under generally accepted dental standards. For example, when an amalgam filling and a composite filling are both professionally acceptable methods for filling a molar, or when a partial denture and fixed bridgework are both professionally acceptable methods for replacing multiple missing teeth in an arch we may base our benefit determination upon the amalgam filling or partial denture which is the less costly service. If we pay benefits based upon a less costly service in accordance with this section the Dentist may charge you or your dependent for the difference between the service that was performed and the less costly service. This is the case even if the service is performed by an in-network dentist
