Dental Insurance Explanation of Benefits 101

Dentist with the male patient presenting discussing dental problems and having a discussion about dental insurance and explanation of benefits

You may be familiar with your medical insurance explanation of benefits, which you may get monthly from your health insurance carrier. Did you know you also get an explanation of benefits (or EOB) for your dental insurance too? Navigating these documents can be confusing, but this guide is meant to help you understand and use your EOB.

What is an Explanation of Benefits?

First of all, the EOB is not a bill. You won’t have to pay the dollar amounts on this document. However, it is a breakdown of all the dental services you had done for that benefits period. For every date of service you’ve received at the dentist’s office, you’ll receive an explanation of benefits.

Why is it Important?

There are three main reasons it’s important to look at your explanation of benefits:

  1. It helps you look at all the procedures or services you had done on any given appointment day.
  2. This lets you find errors, like noticing a service or procedure was billed but not performed.
  3. The EOB will let you know if you have any copays, deductibles, or out-of-pocket expenses that may be billed to you.

How do you read an EOB?

First, confirm:

  • the subscriber and patient name
  • the dental provider who performed the service
  • and the date of service/procedures rendered. 

Next, look at the submitted amount vs the allowed amount.

The submitted amount is the fee that the provider charges for the services rendered. This is a number billed to your insurance company. On the opposite side, the allowed amount is the maximum amount your insurance company has approved to pay to your provider. All policies are different because the contracts between insurance companies and providers may be different. 

Some terms to know:

Your deductible is the amount you pay before your insurance coverage kicks in. This accrual is annual, so it resets every year. Until you’ve hit your deductible, you’ll likely be responsible for any amount up to that number.  

Copays and Co-insurance are dollar amounts or percentages that you will split for payment for your dental services. These typically depend on the service itself and don’t change year to year. 

An annual maximum is the amount of money your dental insurance will pay for services for a benefit holder in any given year. This also will reset annually. 

Your explanation of benefits will map out what was billed, from whom, and for what service. It will also point out what you’ll pay to meet your deductible or as a co-pay for services. Finally, your EOB will indicate how much money is left until you hit your annual maximum.If you notice any errors or have questions while reading your Explanation of Benefits, please call our office at (952) 888-1861 or visit our contact us. Insurance EOBs can be confusing and we would be happy to help you.

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