Allowable Charges definition

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

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

Allowable Charges or “Allowable Costs” means

Examples of Allowable Charges in a sentence

• If a Network Provider or a Participating Provider fails to obtain a required Authorization, We will reduce Allowable Charges by the penalty amount stipulated in the Provider’s contract with Us or with another Blue Cross and Blue Shield plan.

• Covered Services performed in the Outpatient department of a Hospital will be subject to 20% Coinsurance after the Deductible.2. Covered Services performed in the Physician's office or at an Ambulatory Surgical Facility will be provided at 100% of the Allowable Charges after the Deductible.

• If an operation consists of the excision of multiple skin lesions, the total amount covered will be the Allowable Charge for the procedure bearing the highest Allowable Charge, fifty percent (50%) for the procedure bearing the second and third highest Allowable Charges, twenty-five percent (25%) for the procedures bearing the fourth through the eighth highest Allowable Charges and ten percent (10%) for all other procedures.

• The Insurer retains the right to limit or prohibit the use of Providers which significantly exceed Allowable Charges.

• If a Non-Participating Provider fails to obtain a required Authorization, We will reduce Allowable Charges by the amount shown in the Schedule of Benefits.

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 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.

Allowable Charges means the costs of the actual Treatment(s) provided by a Veterinary Provider, subject to Policy limitations and exclusions, additional benefits as provided by the Policy and included on the Declarations Page, the Annual Maximum Benefit, or the Covered Incident Limit amount, except as excluded by the Policy.

Allowable Charges means the Out-of-Network Provider’s billed charges for items or services that qualify as Covered Services.

Allowable Charges means the Group’s charges that qualify as Medically Necessary Covered Services and are eligible for reimbursement 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.