Allowable Charge. The lesser of the submitted charge or the amount established by the Contractor, as provided through Provider Network contracts or based on analysis of Provider charges, as the maximum amount for all such Provider services covered under the terms of this Contract.
Allowable Charge. The charge the Claims Administrator will use as the basis for Benefit determination for Covered Services Incurred by a Covered Person under this Plan. The Claims Administrator will use the following criteria to establish the Allowable Charge:
Allowable Charge. A. For Preferred Providers and Participating Providers - The lesser of the billed charge or the amount We establish or negotiate as the maximum amount allowed for services from these all Providers services covered under the terms of this Contract.
Allowable Charge. For a charge to be allowable, it must be an Allowed Amount and at least part of it must be covered under this Plan. In the case of an HMO or other in-network-only plans, this Plan will not consider any charges in excess of what the HMO or Network Provider has agreed to accept as payment in full. When an HMO or in-network-only plan is primary and the Covered Person does not use the HMO or Network Provider, this Plan will not consider as an Allowable Charge any charge that would have been covered by the HMO or in-network-only plan had the Covered Person used the services of an HMO or Network Provider. In the case of service type plans where services are provided as benefits, the reasonable cash value of each service will be the Allowable Charge.
Allowable Charge. The lesser of the billed charge or the amount established by Xxxxx Vision as the maximum amount allowed for all Provider services covered under the terms of this Benefit Plan. Appeal – A request from a Member or authorized representative to change a previous decision made by the Company about Covered Services. Authorization (Authorized) – A determination by Xxxxx Vision that, based on the information provided, a Benefit satisfies the clinical review criteria requirement for Medical Necessity, appropriateness of the health care setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Benefit(s) – Coverage for the benefits as described in Article IV and the Schedule of Vision Benefits. Benefits provided by the Company are based on the Allowable Charge.
Allowable Charge for Covered Health Care Services, the “Allowable Charge” will be determined as follows:
Allowable Charge. An Allowable Charge for a network Provider means the negotiated fee/rate set forth in the agreement with the participating network health Provider, facility, or organization and the Plan. The Allowable Charge for a non-network Provider means the amount as determined by the Board of Trustees that the Plan will pay for a particular service or supply. The Plan will pay Allowable Charges for out-of-network services or supplies only as determined by the Board of Trustees or its designee. Allowable Charges means the charges that are typically made for services and supplies in the geographic area based on the complexity of treatment received. Amounts that exceed the Allowable Charge will not apply toward the calendar year deductible or out-of-pocket maximum. ASSOCIATION Association means the Louisville Chapter of the National Electrical Contractors Association, Inc.
Allowable Charge. The term “
Allowable Charge. The following allowable charges have been established for the DoD Enhanced Access to Autism Services Demonstration (XXX, Chapter 20, Section 10):
