The maximum amount an insurance company is willing to pay for a covered healthcare service. This is also known as the “allowed charge,” “maximum allowable,” or “negotiated rate.”
The pre-negotiated fee that healthcare providers and insurance companies agree upon for specific medical services. It’s often lower than the provider’s original charge.
A standard used by some insurance companies to determine the allowed amount. It represents the typical cost of a medical service in a particular geographic area.
When a patient receives care from a healthcare provider who is not in their insurance plan’s network, the allowed amount may be lower, and the patient might be responsible for a larger portion of the bill.
The amount a patient must pay for covered healthcare services before the insurance plan starts sharing the costs. Allowed amounts may apply after the deductible is met.
A fixed amount a patient pays for a covered healthcare service, calculated as a percentage of the allowed amount, with the insurance covering the remaining portion.
A percentage of the allowed amount that a patient is required to pay for covered healthcare services, usually after the deductible is met.
When a healthcare provider bills a patient for the difference between the provider’s charge and the allowed amount. This can occur when a patient receives care from an out-of-network provider.
A process where the insurance company reviews and approves a proposed healthcare service in advance. It helps ensure that the service will be covered, and the allowed amount will apply.
A statement sent by the insurance company to the patient explaining how a claim was processed. It includes details such as the allowed amount, patient responsibility, and payments made.