Sarah Beth Herman
How to Read an Explanation of Benefits (EOB)
Understanding Dental Insurance Explanation of Benefits (EOBs) for Dental Office Employees
(Free Training Video Below)
As a dental office employee, you may be responsible for reviewing Explanations of Benefits (EOBs) from dental insurance companies and helping patients understand their coverage. EOBs are summaries of dental insurance claims that include information about the services received, the charges for those services, and the amounts paid by the insurance company. Understanding how to read EOBs is an important part of your job, as it can help you accurately process insurance claims and assist patients with any questions they may have about their coverage.
What is an EOB?
An EOB is a statement that explains the details of a dental insurance claim. It includes information about the patient, the provider (dentist or dental office), the services rendered, the charges for those services, the allowable amounts (the maximum amount that the insurance company will pay), the amounts paid by the insurance company, and any remaining balance that the patient is responsible for paying. EOBs are typically mailed to the patient after the dental office submits a claim to the insurance company and a copy of this accompany's the dental insurance payment made to the dental office (if payment is made on the specific claim).
What information is included in an EOB?
EOBs can vary depending on the insurance company, but they typically include the following information:
Patient information: The patient's name, policy number, and the dates of service
Provider information: The name and address of the dental office or provider
Services rendered: A list of the dental procedures received, the dates they were performed, and the codes used to identify them
Charge amount: The amount the dental office charged for each procedure
Allowable amount: The amount the insurance company considers to be a reasonable charge for each procedure
Amount paid: The amount the insurance company paid for each procedure
Patient responsibility: Any remaining balance that the patient is responsible for paying
Notes: Any additional information or explanations about the claim
In the video below we break down what this looks like and what questions to ask yourself when you review this for full clarity on how to read and understand what is coming through from an insurance company.
Watch this short video on how to read an EOB and share it with your team!
How do I read an EOB?
To understand an EOB, start by looking at the patient and provider information to make sure everything is correct. Then, review the list of services and the corresponding charges, allowable amounts, and amounts paid. Here are a few things to keep in mind:
The charge amount is the amount the dental office charges for each procedure. This is not necessarily the amount the patient will be responsible for paying.
The allowable amount is the maximum amount that the insurance company will pay for each procedure. If the charge amount is less than the allowable amount, the insurance company will pay the full charge amount. If the charge amount is more than the allowable amount, the patient may be responsible for paying the difference.
The amount paid is the amount the insurance company actually paid for each procedure. If the charge amount is less than the allowable amount, the amount paid will be equal to the charge amount. If the charge amount is more than the allowable amount, the amount paid will be equal to the allowable amount.
The patient's responsibility is the remaining balance that the patient is responsible for paying. This may include any deductible, co-insurance, or co-payments that the patient owes.
It's important to note that the EOB is not a bill. It is simply a summary of the services received and how much the insurance company paid for those services. The patient may still receive a bill from your dental office for any remaining balance that they are responsible for paying.
Come back for more training or join the discussion online with The Dental Collaborative.