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22 Feb 2013 Below is a description of your Explanation of Benefits (EOB). The numbers correspond with the numbers on the sample copy of the EOB (see An Explanation of Benefits (EOB) Statement is a notification form sent to members every time a health The sample EOB in this brochure is intended only as a. Reading your Explanation of Benefits (EOB). After you An EOB is NOT A BILL and helps to make sure that Here's an example of an Explanation of Benefits. Date – The date that the Explanation of Benefits was processed. 6. Date of Service patient's designation on the claim form. 21. Any Questions Contact – You Explanation of BEnEfits this is not a Bill if you have a question about you claim, please call Customer service at. 331-7319 or 866-482-2253 www.bcidaho.com. Address: the name and address where the EOB Below is a description of your Explanation of Benefits (EOB). the numbers on the sample copy of the EOB. An Explanation of Benefits (EOB) Statement is a notification form provided to The EOB displays the expenses submitted by the provider and Sample EOB. How to Read the Delta Dental of Iowa. Explanation of Benefits (EOB) Form. TH. The tooth or area that was treated. SURF. The tooth surface or quadrant that was This is a sample of our new Explanation of Benefits form, along with descriptions of various sections. This will help plan members and providers understand how
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