The Anatomy of a Dental Insurance Plan

Harnessing the task of understanding the different types of dental insurance is one thing, but on top of that, it is important that you understand the anatomy of an individual dental insurance plan, too. 


Always keep in mind that every dental insurance plan is different, so it is crucial to review the specific details of a patient’s plan before providing any estimates or discussing finances at all. By understanding the anatomy of a dental insurance plan, you will be well-equipped to help your patients to maximize their benefits and make informed decisions about their dental care. 



Explanation of Benefits (EOBs) 

Oftentimes, while working with dental insurance companies you will encounter an Explanation of Benefits (EOB). An EOB is a document that details the insurance company’s payment or denial of a dental claim. It will provide helpful information about the patient’s specific benefits, how much the insurance company paid, and also how much the patient still owes, if anything.


Your dental practice will have its own unique way of storing and handling patient EOBs. These methods are often determined by state or local dental association requirements, so as to better protect patient confidentiality. 


There are five things that you will find in a patient’s EOB: 


  1. Claim information, or what was submitted by the dental office.
  2. Service and coverage information, or in other words, the details of the patient’s dental insurance plans and the benefits that they are owed by it. 
  3. Explanation of whether the claim was paid, or whether it was denied. 
  4. Patient identifiable information such as policy number, group number, date of birth, and more. 
  5. Details on resubmissions needed, if applicable. 


Some items might look confusing at first for those who are newer to dental terminology. Here’s a breakdown of common terms you might see on an EOB, and what they mean: 



EOBs are an important factor to understand when learning how to work with dental insurance companies. By working to understand EOBs properly, you will be able to ensure that your practice receives the payment that it is due and that the patients better understand their benefits and the limitations of their insurance, as well as the balances they may owe. This will work wonders in preventing financial surprises and keeping patients well-informed, and therefore less upset or stressed about the financial aspects of their treatment.