Allowed Amount definition
Allowed Amount means the total amount of reimbursement allocated to a covered Service and includes both the BCBSAZ payment and the Member Cost-share payment. BCBSAZ calculates deductible and Coinsurance based on the Allowed Amount, less any access fees or Precertification Charges. BCBSAZ uses the Allowed Amount to accumulate toward any Out-of-pocket Coinsurance Maximum or Out-of-pocket Maximum that applies to the member’s Benefit Plan. The Allowed Amount does not include any balance bills from noncontracted Providers. The Allowed Amount is neither tied to, nor necessarily reflective of, the amounts Providers in any given area usually charge for their services. The table below shows how BCBSAZ determines the Allowed Amount:
Allowed Amount means the maximum amount established by AvMed upon which payment will be based for Covered Services rendered by Participating Providers. The Allowed Amount may be changed at any time without notice to you or your consent.
Allowed Amount means the maximum amount We will pay for the services or supplies covered under this Certificate, before any applicable Copayment, Deductible and Coinsurance amounts are subtracted. We determine Our Allowed Amount as follows:
Examples of Allowed Amount in a sentence
In addition to Cost-Sharing, You will also be responsible for paying any difference between the Allowed Amount and the Non-Participating Provider’s charge.
See the Cost-Sharing Expenses and Allowed Amount section of this Contract for a description of how We calculate the Allowed Amount.
You must pay the amount of the Non-Participating Provider’s charge that exceeds Our Allowed Amount.
Any charges of a Non-Participating Provider that are in excess of the Allowed Amount do not apply towards the Deductible or Out-of-Pocket Limit.
The Allowed Amounts provision near the end of this Schedule of Benefits will tell you when you are responsible for amounts that exceed the Allowed Amount.
More Definitions of Allowed Amount
Allowed Amount means the maximum amount We will pay for the services or supplies covered under this Contract; before any applicable Copayment, Deductible and Coinsurance amounts are subtracted. We determine Our Allowed Amount as follows: The Allowed Amount for Participating Providers will be the amount we have negotiated with the Participating Provider. The Allowed Amount for Non-Participating Providers will be determined as follows: For Providers, the Allowed Amount will be an amount based on Our Participating Provider fee schedule or rate.
Allowed Amount means the maximum portion of a billed charge
Allowed Amount means the sum at which a Claim is Allowed.
Allowed Amount means the total amount of reimbursement allocated to a covered service and includes both the BCBSAZ payment and the member cost-share payment.
Allowed Amount means the dollar amount in which a Claim is allowed.
Allowed Amount means the maximum portion of a billed charge a health carrier will pay, including any applicable enrollee cost- sharing responsibility, for a covered health care service or item ren- dered by a participating provider or facility or by a nonparticipating provider or facility.
Allowed Amount means, for services or supplies received from a Network Provider, the amount agreed upon by Us and the Network Provider for the Covered Service. For services or supplies received from a non-Network Provider, the Allowed Amount will be no greater than the maximum amount We otherwise would have allowed had the Covered Service been furnished by a Network Provider. We reserve the right to determine the Allowed Amount for any service or supply.