Allowable Charges definition

Allowable Charges means a Contracted Provider’s billed charges for services that qualify as Covered Services.

Split View

AI-Powered Contracts

Draft, Review & Redline at the Speed of AI

Get StartedSchedule a Demo

Allowable Charges means the charges agreed to by the Preferred Provider Organization for specified covered medical treatment, services and supplies.

Allowable Charges means an amount, on a per claim basis, not to exceed the lesser of 23 100% of CalOptima’s fee-for-service reimbursement rates, less required co-payments or 100% of billed 24 charges, less required co-payments.

Examples of Allowable Charges in a sentence

• We will pay the Total Allowable Charges for a living donor who is not entitled to benefits under any other health benefit plan or policy.

• You may elect to continue to receive care from this Out-of-network Practitioner/Provider; however, we will only reimburse for such services in accordance with applicable Out-of-network benefit level, if any, and then subject to Medicare Allowable Charges except when you wish to continue an ongoing course of treatment with the provider for a transitional period.

• We will reimburse the Practitioner/Provider the balance for Covered Services based upon Total Allowable Charges (some services may not require a Cost Sharing Deductible, Coinsurance and/or Copayment).

• We will reimburse the Practitioner/Provider the balance for Covered Services based upon Total Allowable Charges (some services may not require a Cost-Sharing Deductible, Coinsurance and/or Copayment).

• Hospital Benefits Medical and Surgical Benefits Prescription Drug Benefits Benefits for Other Covered Services, Your Schedule of Benefits tells You the percentage of Allowable Charges We pay for Covered Services and the percentage You pay.

More Definitions of Allowable Charges

Allowable Charges means the Usual and Customary charge for any Medically Necessary, Reasonable, and eligible item of expense, at least a portion of which is covered under a plan. When some Other Plan pays first in accordance with the Application to Benefit Determinations section, this Plan’s Allowable Charges shall in no event exceed the Other Plan’s Allowable Charges. When some Other Plan provides benefits in the form of services rather than cash payments, the reasonable cash value of each service rendered, in the amount that would be payable in accordance with the terms of the Plan, shall be deemed to be the benefit. Benefits payable under any Other Plan include the benefits that would have been payable had claim been duly made therefore.

Allowable Charges means the maximum amount to be allowed as Eligible Expense for services rendered by a Provider (Hospital or Physician) under contract with the Blue Cross or the Plan’s designated PPO provider. This amount will also apply to charges for services rendered by Physicians who are located in the geographic area serviced by the PPO but are not under contract with the PPO.

Allowable Charges or “Allowable Costs” means:

Allowable Charges means the maximum amount to be allowed as Eligible Expense for services rendered by a Provider (Hospital, Physician or other licensed healthcare professional) under contract with the Anthem Blue Cross or the Plan’s designated PPO provider subject to the Plan’s Usual, Customary and Reasonable provisions. This amount will also apply to charges for services rendered by all service providers Physicians who are located in the geographic area serviced by the PPO, but are not under contract with the PPO, to the extent such services are considered Eligible Expense under the Plan.

Allowable Charges or “Allowable Costs” means a maximum of one hundred thirty percent 15 (130%) of the national Medicare Resource Based Relative Value Scale (RBRVS),less the required co- 16 payment as specified herein, for charges that are determined by the Intermediary to be attributable to 17 reimbursable services to Eligible Persons in accordance with all Agreements for the MSI Program.

Allowable Charges means United States Fire Insurance Company allowance for a specified Covered Medical Expense of the Provider’s charge for the service, whichever is less.

Allowable Charges means either for: