Explanation of benefits (EOB)

A statement from your insurer that explains how it processed a claim or estimated a treatment. MetLife says it details what services it will cover and at what payment level. It is not a bill. Read it against your treatment plan and keep it with your records.

No. It explains how the plan processed a claim, including what it paid and what you may owe. You pay the dental office, not the insurer, for your share. If an EOB shows a balance you did not expect, check it against the dentist's statement before paying.

MetLife says actual payments may vary from a pretreatment estimate depending on annual maximums, deductibles, plan frequency limits and other provisions at the time of payment. Other reasons include coding differences and claims processed in a different benefit year. Ask the plan to explain each difference.

It is the fee the plan recognizes for a service. A network dentist accepts it as payment in full, apart from your deductible and coinsurance. An out-of-network dentist may bill above it. See the glossary entry on the allowed amount.

Keep them with your treatment records and receipts, and compare each with the dentist's statement. They help you track your annual maximum and deductible, catch errors and support an appeal if a claim is denied. Store a copy in case you change plans.

Ask the dental office to send the plan a pretreatment estimate. MetLife says that when the dentist sends a claim form with the proposed treatment plan, an EOB comes back to you and the dentist detailing an estimate. Ask the plan how long it takes, and whether it covers each procedure code.

Usually the patient or the plan member, and the dentist receives a corresponding statement. MetLife says an EOB will be sent to you and the dentist for a pretreatment estimate. If someone else holds the policy, they may receive it. Ask the plan how it delivers statements.

It can mean the plan paid toward a cheaper material or procedure than the one performed, under an alternate benefit provision. You owe the difference. See the alternate benefit page, and ask the plan to explain the provision in your policy.

Read the reason. It may be a coding error, a missing document, a waiting period, an exclusion or a limit. Ask the dental office to check the claim, and ask the plan for its appeal process and deadlines. See the guide to dental claim appeals.

Yes. Each EOB shows what the plan paid, so adding them up shows how much of the annual maximum you have used. Compare with the plan's own balance figure, since pending claims may not be counted yet. Use the annual maximum planner.

At least as long as the treatment matters and for any tax or appeal purpose. Keeping them for several years is common. Store copies with your treatment records and receipts, especially for implants, dentures and other work that may need documentation later.

Not exactly. The pretreatment estimate is the request the dentist submits before treatment, and the EOB is the insurer's response. Ask for the response in writing, and keep it. Payment is not guaranteed, because limits and eligibility can change.