The maximum amount a plan will pay for a covered health care service. May also be called “eligible expense,” “payment allowance,” or “negotiated rate.”
See Also
Pitfalls of Inaccurate Coding and Billing in Healthcare - BellMedExCheck your medical bill for errorsHow long to resolve a billing error dispute on my credit card account?What Does Allowed Amount Mean on a Health Insurance Statement?If your provider charges more than the plan’s allowed amount, you may have to pay the difference. (See
When a provider bills you for the difference between the provider’s charge and the allowed amount. For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.
Refer to glossary for more details.
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