Understanding Your Dental EOB: A Sample Walkthrough

What is an Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) is a crucial document sent by dental insurance companies to both the dental office and the patient after a claim has been processed. While an EOB is not a bill, it details how the claim was evaluated, what was covered, and what the patient may still owe. Understanding EOBs is essential for dental billing teams to reconcile accounts receivable (AR), address claim denials, and communicate clearly with patients about their financial responsibility.

Key Sections of a Dental EOB

A typical dental EOB contains several standardized sections. Knowing how to interpret each part helps dental offices streamline their billing and follow-up processes:

 
• Patient Information: Identifies the patient and their policy details.
 
• Provider Information: Lists the treating dentist and practice details.
 
• Claim Details: Includes the date of service, CDT procedure codes, and descriptions of services rendered.
 
• Submitted Charges: The amount billed by the dental office for each procedure.
 
• Allowed Amount: The maximum amount the insurer will pay for each service, based on the patient’s plan.
 
• Amount Paid by Insurance: The portion covered by the insurance plan.
 
• Patient Responsibility: What the patient owes after insurance, including deductibles, co-pays, and non-covered services.
 
• Reason Codes/Remarks: Short codes or notes explaining adjustments, denials, or partial payments (e.g., “service exceeds plan maximum”).

How to Use EOB Information in Your Billing

Dental billing teams should use EOBs as a roadmap for efficient revenue cycle management (RCM). Here’s how to maximize their value:

 
• Reconcile Payments: Match insurance payments in your practice management software to the amounts listed on the EOB. Address any discrepancies immediately.
 
• Post Adjustments: Use the EOB’s allowed amounts and reason codes to post contractual adjustments or write-offs accurately.
 
• Communicate Patient Responsibility: Clearly explain any remaining balance to the patient, referencing the EOB for transparency.
 
• Appeal Denied Claims: If a service is denied or underpaid, use the EOB’s explanation and reason codes to file a timely, well-documented appeal. Attach supporting documentation as needed.
 
• Track Trends: Monitor EOBs for recurring issues, such as frequent denials for the same CDT code, and adjust your verification or documentation processes accordingly.

Common Questions About EOBs

Q: Is an EOB a bill?
A: No, an EOB is not a bill. It’s a summary of how your dental insurance processed a claim. The patient may still receive a separate bill from the dental office for any remaining balance.

Q: What should I do if a service is denied?
A: Review the reason code or remarks on the EOB. If the denial is due to missing information or a documentation error, submit a corrected claim or appeal with the required details.

Q: How soon should EOBs be reviewed?
A: Best practice is to review EOBs as soon as they are received, ideally daily, to ensure prompt posting, follow-up, and patient communication.

Q: Can patients get a copy of their EOB?
A: Yes, patients can request a copy from their insurance carrier or access it through their online member portal. Dental offices should also keep copies for their records.

By understanding and effectively using dental EOBs, your practice can improve billing accuracy, reduce AR days, and provide better service to your patients.