Understanding Your Dental Explanation of Benefits
An Explanation of Benefits, or EOB, is a document you’ll receive when your claim is processed.
Your Dental Explanation of Benefits (EOB) from Horizon Blue Cross Blue Shield of New Jersey helps you understand how your dental plan pays claims. Register and sign in to Member Online Services at HorizonBlue.com/members to view, download and print your EOB.
|
A |
Tooth # – Surface |
The tooth number and surface(s) on which services were performed. |
|
B |
Service Date |
The date that services were provided to the patient. |
|
C |
Proc. Code |
The dental procedure code used to describe the procedure/service. |
|
D |
Procedure Description |
A brief explanation of each service. |
|
E |
Submitted Amount |
Amount billed to Horizon BCBSNJ by the dentist or facility. |
|
F |
Approved Amount |
The amount we approved for payment based on your plan benefits prior to the deductible, coinsurance, copayment or other member cost sharing, if applicable. |
|
G |
Allowed Amount |
The amount your Horizon BCBSNJ plan allows for the services performed. |
|
H |
Network Savings |
The difference between the submitted amount and the approved amount. |
|
I |
Deductible Amt. |
The amount you pay each year before your Horizon BCBSNJ dental plan starts to pay for covered services. |
|
J |
Cov. % |
The percentage of the approved amount covered by insurance based on your plan benefits |
|
K |
Patient Owes |
The amount the patient must pay to the dentist or facility, including deductible, copayment and coinsurance. |
|
L |
Plan Payment |
The amount Horizon BCBSNJ pays the dentist or facility based on your plan benefits. |
|
M |
Other Insurance Coverage Paid |
The amount paid by another insurance carrier, if applicable. |
|
N |
Current Plan Payment |
The total amount paid to you, your dentist or facility for the services performed |
