Understanding Your Explanation of Benefits (EOB)

Posted on September 18, 2015 in Dental benefit information

When you are covered by a dental plan, you often receive an explanation of benefits (EOB) from your dental carrier after a trip to the dentist's office. The EOB is not a bill, but rather an explanation of the procedures that were performed at the appointment and what is covered by your particular dental plan.

The content of an EOB varies across dental benefits companies. However, most include the dentist’s fee, the portion your plan paid and any amount you may owe (such as the deductible, coinsurance or non-covered services). It should also include an update on how much of your annual maximum has been used and the amount you have paid toward your deductible.

You should always review your EOB to make sure the services and amounts have been billed correctly. See below for what to look for when reviewing your EOB.

A. This section contains member and patient identification information, dentist name and the claim number, which you'll need to check on a claims status or dispute a claim.

B. The Procedure Code and Procedure Description explain the services received at the dentist's office.

C. Submit Amount is the amount the dentist charged for the services.

D. The Approved Amount shows Delta Dental's contracted fees for each procedure. Allowed Amount is the amount determined by the dental benefit plan. These amounts are often the same. If they differ, it's because of provisions in the contract your employer purchased.

E. If you have a procedure that is not completely covered by Delta Dental, the Deductible Applied is the amount applied to the service. You must pay the deductible before Delta Dental picks up its share of the tab.

F. Delta Dental Co-Pay identifies the percent the plan will cover per procedure.

G. Patient Payment is the amount the patient owes the dentist. Your dentist should not bill you more than this amount. Delta Dental Payment is the amount Delta Dental paid your dentist for services rendered.

H. This section includes detail about Delta Dental's payment to your dentist.

*Some EOBs will have additional messages to help patients understand why a procedure wasn't paid.

Understanding Your EOB