After your visit to the dentist, your insurance administrator reviews your claim to determine your benefits, and you will receive an Explanation of Benefits (EOB) outlining the details of your processed claim. This EOB explains the portion of provider’s charges that are covered under your insurance policy.
A dentist who is part of your provider’s insurance network will usually send your bill to have the network discount the portion you’re responsible for. Next, the claim will be sent on to the administrator of your insurance for processing.
However, if your dentist is not in network with your insurance plan, we will send the bill to you or your insurance company. If you receive the bill directly, you will then submit the claim to your insurance administrator.
At our office, we will usually send the bill to the insurance company first, and once we receive payment from the insurance company for their covered portion we will then send a bill to the patient for the remaining balance. We can usually give the patient a close estimate of what their portion of charges will be, but sometimes there still may be a remaining balance that the patient is responsible for after their insurance company has paid their portion of the balance.
If you have a second dental insurance plan, the two insurance companies will work together to identify which plan is responsible for which portion of the charges. In this case, the administrator of your insurance sends the Explanation of Benefits directly to the provider. Where appropriate, your provider will also receive a reimbursement check.
Remember that the Explanation of Benefits is not a bill; it simply explains the portion that was covered by insurance. The provider/dental office may bill you separately for any charges you're still responsible for after the insurance company has paid their portion of the charges.