The most your health plan will pay for a covered service. You may see the phrase, "The actual charge may be different from the allowable charge." This means your health plan may only cover a portion of what your doctor charges you. For example, your doctor bills you $35.00 for an office visit. This is the actual charge. But your health plan may only accept $32.00 for an office visit. This is the allowable charge.
The amount Medicare considers a reasonable charge for medical services or supplies based on the usual or customary charges in your area (Medicare pays 80% of the amount).
The maximum amount that a health plan will pay for a given covered service or supply based on the providerâ€(tm)s geographic region.
The maximum amount that a Health Benefit Plan will pay for a given Covered Service or supply. Also called Maximum Benefit Allowance, Maximum Allowance.
Charges for medical services or supplies provided by a hospital or physician which qualify as covered expenses as stated in the health plan’s certificate of coverage.
This is the largest amount an insurer will pay for a specific supply or service. It is also known as the reasonable and customary charge.
the amount covered prior to any reductions due to coinsurance or deductible amounts.
The maximum fee that a health plan will reimburse a provider for a given service.
The dollar amount upon which benefits will be determined. Any amounts (other than copayments) a covered person is required to pay will be based on this allowable charge. Benefits limits, if any, will also be based on this allowable charge. The allowable charge may vary depending upon whether or not the provider is a participating provider and the terms of that provider's contract with BCBSKC.
TRICARE figures the allowable charge from all professional (non-institutional) providers' charges nationwide, with adjustments for specific localities, over the last year. The claims processor can verify the allowable amount for specific services per TRICARE guidelines. The allowable charge is also known as the TRICARE Maximum Allowable Charge (TMAC).
The maximum fee an insurance company will reimburse a Provider for a given service.
The charge that in-network providers are allowed to bill you based on their contract with Chickering. When you use PPO network providers, you pay less because your share of the cost is based on a pre-negotiated, reduced charge.
The maximum charge for which a third party will reimburse a provider for a given service. An allowable charge is not necessarily the same as either a reasonable, customary, maximum, actual, or prevailing charge.
Average or maximum amount the third party payer will reimburse providers for the service. Back to the top of the page
The maximum dollar amount on which benefit payment is based for each dental procedure