HomeMy WebLinkAboutRESPONSE - RFP - 7649 DENTAL ADMINISTRATOR (18)Each time a Delta Dental subscriber visits the dentist, he or she receives an Explanation of Benefits (EOB) following the visit. This docu-
ment is NOT a bill. Rather, it provides a breakdown of your dental benefits and how your recent dentist visit impacted them. If you are
having trouble understanding your EOB, use the guide below. It will help you understand each section of your EOB.
1. Mailing address and phone number for Delta Dental of Colorado Customer Relations — for claims and correspondence.
2. Date the claim was processed, dentist/facility that provided the dental services, network and provider identification number.
3. Name of subscriber, patient receiving dental services, relationship of patient to subscriber and subscriber’s group number.
4. Claim number — assigned to claim when it was received.
5. Date(s) that dental services were
received, service(s) performed
and charge(s) submitted by
dentist.
6. The approved dollar amount and
the allowable amount, based on
the dentist’s network participa-
tion and the subscriber’s benefit
plan.
7. The amount the subscriber must
pay toward the deductible, if any,
prior to Delta Dental paying
benefits
8. The percentage that Delta Dental
will pay toward your benefits,
based on the allowed amount,
less any deductible.
9. The dollar amount(s) to be paid
by the patient and Delta Dental.
10. Explanation(s) that provide
additional information about
how a dental procedure is
processed. The number
displayed in the column
corresponds with the number(s)
under the “Processing Policy
Explanation” section below.
11. A summary of the benefit year
maximum (i.e., the general year
maximum), the benefit
maximum used to date, the
amount of deductible (if any)
satisfied, the total payment by
Delta Dental to the dentist, the
amount the dentist is not allowed
to charge the patient and the
patient’s share of the charges.
A guide to understanding your
Explanation of Benefits (EOB)
EOB0912
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Note: The Orthodontia Paid
to Date only appears if Ortho
benefits are being used.