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Delta Dental has recently revised its Explanation of Benefits (EOB) form. You will see that the term "allowed amount" has been replaced with "Amount Used for Benefit Calculation." Our intention is to provide greater clarity. In addition, both the "approved amount" and "Amount Used for Benefit Calculation" are defined in the EOB so dentists and subscribers have a clear understanding of those terms.
Approved amount is "The total amount which the dentist is permitted to collect as payment in full for the specified service. It includes the dental benefit plan's payment as well as the patient's deductible and/or copay."
Amount Used for Benefit Calculation is "The fee amount that the dental benefit plan provides for use in calculating the dental benefit plan payment for the specified service. The dental benefit plan payment may be less than this fee amount due to patient deductible, copay, plan limitations or exclusions."
You will soon be seeing changes in other Delta Dental documents as we discontinue use of "UCR" and "Prevailing Fee" terminology.
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