My bill doesn't match my Explanation of Benefits

• Allowed amount: the fee the plan recognizes for each service.
• Deductible: the amount applied to your deductible.
• Coverage percentage: the share the plan paid.
• Amount paid: what the plan sent the dentist.
• Patient responsibility: what the plan says you owe.
• Remark codes: notes, usually at the bottom, that explain why something was reduced or denied.

For a covered service at an in-network dentist, the plan's payment plus your share should equal the allowed amount. At an out-of-network dentist, they should equal the dentist's full fee. Out-of-network offices often collect the full fee up front, and the plan then pays you back directly, so your bill and EOB may not line up until that payment arrives.

• The office billed you before the insurance payment arrived or was recorded.
• The office billed you before your second insurance plan paid.
• The service wasn't covered, and the office charged its regular fee.
• A simple billing error, such as a wrong code or date.

1. Ask the office for an itemized statement with dates and procedure codes.
2. Match each line to your EOB by date and code.
3. Call the office's billing person (not the front desk) with specific lines that don't match.
4. If the plan processed it wrong, ask the office to resubmit the claim or appeal it for you. If that isn't getting anywhere, call the member services number on your insurance card and ask what options you have. See How do I appeal?