DENTAL INSURANCE

Understanding an Explanation of Benefits

6 min read
Sep 19, 2025

An explanation of benefits, or EOB, is a statement from your health or dental insurance company that breaks down what you owe after filing a claim. It's not a bill, but rather an explanation of what your insurance covers and what you'll have to pay, if anything, after you visit a doctor, dentist, or other healthcare provider. It's important to read over your EOB so you understand the details of your benefits and why a procedure was or wasn't covered. You can also follow up with your insurance or healthcare provider if you see any discrepancies after receiving your final bill. 

Introduction to explanation of benefits (EOB)

An explanation of benefits details your insurance benefits and total charges after you visit a doctor or dentist. You'll receive an EOB each time you use your insurance for a healthcare appointment. While an EOB is not a bill, it plays an important role in healthcare billing and insurance, as it breaks down your claim, coverage, and costs.

Reading over your EOB is important, because it fills you in on what costs your insurance covers and what you'll be responsible for paying. You can also be on the lookout for any mismatch between your EOB and the bill you eventually get from your healthcare provider. If the doctor is asking you to pay a higher amount, for instance, you can refer to the explanation of benefits and speak to the doctor or call your insurance company to resolve the issue. 

Make sure to hold on to your EOB until you've received your final bill (or longer if you're dealing with a long-term condition). By providing information on your insurance coverage, including deductibles, copays, and reimbursement limits, EOBs can help you prepare for your medical and dental costs.

Are you a MetLife Dental Insurance plan member? Find your explanation of benefits for any recent procedure by logging in to MyBenefits.

Decoding the EOB: Key components and their meanings

There's no universal format for EOBs across insurance companies, but you'll generally see the following among the insurance terms you’ll see:1

  • Details of medical or dental care: Your EOB will include provider information, including the date of your doctor or dentist visit and a description of the services, such as a sick visit or oral evaluation. 
  • Billed amount: This is the amount your provider billed to the insurance company for your visit.
  • Allowed amount: This is how much your insurance company allows for the service you received. If your provider overcharges, your insurance will adjust the difference — you won't have to pay the extra amount. 
  • Deductible: The deductible is the amount you must pay out of pocket before your insurance company starts to reimburse your claims. Your deductible typically resets on an annual basis.
  • Paid amount: This is how much your health insurance plan will pay to your provider.
  • Patient balance: This is the patient's responsibility. It's how much you have to pay after your insurance company has applied your benefits.
  • Benefit codes: Also known as remark codes, these are a short sequence of letters or numbers your insurance company uses to describe costs, adjustments, and how it processed your claim.  

On a MetLife dental EOB, to give an example, you'll see a detailed breakdown of the services you received with descriptions; the costs associated with each service; the allowed amount by your insurance plan, based on the rate negotiated with the provider; the insurance payment, or how much MetLife will pay, and the patient’s responsibility, which is what you are expected to pay. This information helps you understand how your benefits are being applied.

Your MetLife explanation of benefits may also include additional notes or remarks explaining any adjustments or denials of the claim. This helps the patient understand why certain amounts were not covered.

Along with your deductible, your coinsurance and copayment all factor into the what the patient responsibility amount will be. Coinsurance refers to the percentage of costs that you share with your insurance provider. For example, your insurance company might cover 80% of costs, while you pay for the remaining 20%. 

Copays are the fees that you pay when you visit your doctor or dentist, usually in the office at the time of service. You might have a $20 copay at the dentist office, regardless of whether or not you've hit your deductible.

Navigating medical billing and claims 

After you visit a doctor or dentist, your service provider will send a claim to your insurance company for it to review and process. 

Your insurance will apply any adjustments, deductibles, and coinsurance to determine what it will cover and what you'll have to pay. Then, it will put together your explanation of benefits and send it your way. If you owe a balance, your healthcare provider will bill you directly.

After receiving your bill, compare your balance to your EOB to make sure it matches. If your doctor or dentist is overcharging you, call your provider or insurance company to pinpoint the issue. If there was an error in the claim, the provider may need to submit new paperwork. 

If you think your insurance is unfairly denying your claim, consider submitting an appeal. You will need to provide supporting documents for your appeal, which could include notes from your provider or other medical records. Your EOB may contain instructions for how to file an appeal.2

As a patient, you have the right to file an appeal and request information about why your claim was denied. You may also be able to request that an independent third party review your case.3

 Is MetLife’s PPO, HMO, TakeAlong or other dental insurance plan right for you and your family? Compare the coverage and costs.

Maximizing your healthcare benefits

If you've got health insurance, dental insurance, or both, it's important to maximize your benefits. Here are some tips for making the most of your plan:

  • Schedule preventive services: Check-ups, like annual physicals and dental cleanings, are often fully covered and can help prevent health issues before they arise. 
  • Understand your coverage: Check out your plan summary and EOBs so you understand your coverage, including any deductibles and out-of-pocket maximums.
  • Track what you've used so far: Monitor your deductible, copayments, and coinsurance and how they contribute to your out-of-pocket maximum. That way, you can time your medical or dental treatments or procedures so you'll get the most coverage and keep your own costs down.
  • Use your benefits before they reset: Benefits usually reset annually, so find out when yours expire, mark the date on your calendar, and use your benefits before they disappear. 
  • Choose in-network providers: While you may have the option of visiting out-of-network doctors and dentists, the costs could be much higher. Going in-network could keep your out-of-pocket costs down.

Understanding coverage and patient rights

As a patient, you have certain rights when it comes to your health and dental care. Patient’s rights were originally formed by the American Hospital Association, and include:

  • Accurate information to help you make informed decisions about your treatments
  • Respect and considerate care from members of the healthcare system
  • Confidentiality about your healthcare information
  • Explanation of costs for services 
  • Ability to resolve issues through filing complaints or appeals4

Other medical providers and institutions may formulate their own patient’s bill of rights. Check with your provider to see if they offer their own version.

You can use your EOB to ensure that your rights are being respected, especially when it comes to receiving accurate information and ensuring your health and dental insurance are providing the right coverage. 

If you believe your rights have been violated, start by calling your healthcare provider or insurance company to see if you can reach a resolution. If there's still a problem, you could try filing an appeal.

For ongoing issues, consider filing a complaint with your state’s Department of Insurance or Attorneys General's office. You might also consult an attorney for legal advice around denial of coverage or other issues. 

Digital tools and resources for EOB management

Many insurance companies, including MetLife, give you the option of receiving your EOBs electronically, rather than by mail. MetLife's MyBenefits portal makes it easy to access your EOBs all in one centralized place. 

You can easily navigate to your documents, search for specific claims, or filter by date to quickly locate the information you need. In the MyBenefits portal, you can also check the status of your claims in real-time and understand the reasons behind any decisions made by the insurance company.

Plus, you have the option to download and print your EOBs directly from the portal and to contact MetLife's customer support for assistance with any issues or concerns.

When comparing digital tools for managing your EOBs, look for ones that are easy to navigate. It can also be helpful if the portal offers mobile access and multilingual support. 

Referring to your explanation of benefits

EOBs are informative documents in the world of healthcare costs. They break down everything you need to know about your medical and dental costs, including the initial provider bill, what your insurance covers, and the remaining balance that you, the patient, has to pay. 

If your provider asks for a higher amount, you can use your EOB to point out the mismatch and get it resolved. Understanding what your EOB is and how to read it is crucial for managing your healthcare expenses and making the most of your insurance benefits.

If you’re a MetLife Dental Insurance Plan member,  you can long on to MyBenefits to access all your EOBs in one place and maintain a detailed record of your medical and dental visits. Proactively reviewing your benefits before and after you receive services can help you stay on top on your dental care and maintain your financial well-being. 

FAQs

An out-of-pocket maximum is the upper limit of what you'll have to pay for healthcare or dental services in a year. It includes your deductible, as well any copays and coinsurance amounts. Once you've hit this maximum, your insurance will pay for remaining covered costs.5

You should save EOBs at least until you've received and paid off your final bill for your medical or dental service and received confirmation that your bill has been paid in full. If you run into any discrepancies, save your EOBs while you get the issue resolved. You could hold onto your benefits statements longer if you're dealing with a chronic or recurring condition that requires ongoing treatment.

While there's no standard format for a medical bill, most will contain the cost of your medical service, what your insurer paid, and what your patient balance is. It will also provide details about the services you received and the date you got them. Read over your medical bill to make sure everything looks accurate, and there aren't any unexpected costs.