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Dental Benefit Plan Handbook – Chapter 08: Explanation of Benefits

October 01, 2020 3774

Confirmation that your claim has been processed comes in two forms: a check and/or an Explanation of Benefits (EOB), sometimes called a Notice of Payment (NOP).

An EOB is a written statement to the party who has filed the claim. If the provider is in network with the plan, the EOB is sent to the dental office with a copy going to the patient. If the provider is out of network and the plan/group does not allow assignment of benefits, the EOB and/or check will be mailed to the patient. The EOB indicates which benefits or treatment procedures were or were not covered. It reflects if payment was made for the service and how much the plan paid for each procedure and what, if anything, is the responsibility of the patient to pay.