The Practicon Viewpoint by Ann Page Griffin

EOBs: A FREQUENT AGGRAVATION IN DENTAL OFFICES

Employees across the country value the dental insurance plans that come with their jobs and the benefits they provide. However, dentists and team members who deal regularly with payments and Explanation of Benefits forms (EOBs) from third-party payers know the extent of the time and effort required to decipher EOB statements and clarify to patients their payment responsibility.

Responding to inquiries from dentists, the ADA published a series of articles in early 2018 entitled Decoding Dental Benefits. The ADA has also posted a landing page for specific questions, problems, and concerns about dental benefits and EOBs.

Common complaints among staff tasked with handling EOBs include:

• EOB statements are not required to follow standard formats, standard definitions, or standard terminology.
• Some third-party claim forms lack sufficient information to allow claims to be processed.
• Some EOBs erroneously report what the third party paid, what the provider received, and how the patient's share of the fee was determined. This factor alone accounts for many misunderstandings between the dentist and the patient because the patient is convinced that the statement from the benefits provider is correct.
• Language and terminology on many EOBs is confusing, and can even lead to a patient leaving a practice when staff explanations are unsatisfactory. Talk about stress for business staff members!

In an effort to rectify the problems, the ADA has published a position paper on the subject. For help answering specific questions, dentists can call the ADA Center for Dental Benefits, Coding and Quality at 1-800-621-8099 or email questions and concerns to dentalbenefits@ada.org.