Navigating dental insurance terms and documents can feel like deciphering a foreign language. One such document that frequently leaves patients scratching their heads is the Explanation of Benefits (EOB).
What is an EOB?
An Explanation of Benefits, commonly referred to as an EOB, is a paper or digital statement sent by your dental insurance provider detailing the costs of services or treatments that they have covered on your behalf as well as any charges you’re responsible for.
While it may seem similar to a bill at first glance, an EOB serves a different purpose altogether. Instead of indicating the amount you owe, it serves as a summary of the claims processed by your insurance company, outlining what services were provided, the associated costs, and how much your insurance covers. If your procedure with your dentist was fully covered, you won’t receive an EOB. That’s because the rate the dentist requested was covered by us.
Why is an EOB important?
An EOB provides information about any outstanding payments owed to your dentist. It also serves as an opportunity to verify that you’ve been accurately billed for the services and to ensure that the charges align with your plan’s coverage.
It’s important to review your EOB to check for any billing mistakes. Typically, an EOB provides information such as the treatments administered, dentist fees, insurance reimbursements, potential costs for deductibles or copays, details on procedures not covered by your policy, coordination of benefits (if applicable), utilization of your annual maximum, and your contributions toward the deductible in the current benefit year.
An EOB is a way to keep all parties involved informed and honest. It allows us to communicate to you, our member, what exactly you are financially responsible for. You shouldn’t ever pay any more or any less than what is stated on the EOB. If your statement says, “not chargeable to patient” anywhere, this is a reflection that the dentist has to “take a write-off,” or they billed above what their contracted rate allows.
What to do if there is a mistake on your EOB
You shouldn’t have to take any action when you receive an EOB. However, if you didn’t have the services listed on the document done or if something looks to be incorrect from what you recall during the treatment, it’s important to contact us.
*Updated April 2024
