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

• Coverage for Emergency services at a non-Network Facility is limited to the Allowed Amount.

• After you meet your Deductible, HNE will pay a percentage of its Allowed Amount, and you pay the Copay or Coinsurance shown in the Summary of Benefit Chart in Appendix A.

• If Delta Dental of Illinois’ Coverage Percentage is 80% of the Allowed Amount, You would be responsible for the remaining 20%.Coverage Limits: The maximum number of times You, or Your covered family members, can receive a specific service in a year, which is based on Your Benefit Period.

• Any amounts paid for non-Covered Services or amounts in excess of the Allowed Amount do not qualify as an out-of- pocket expense.VI.

• Amounts over the Allowed Amount Costs over the allowed amount as defined by this plan for non-emergency services from a non-participating provider.

More Definitions of Allowed Amount

Allowed Amount means the sum at which a Claim is Allowed.

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 For Providers, the Allowed Amount will be an amount based on Our Participating Provider fee schedule or rate. Our Allowed Amount is not based on UCR. The Non-Participating Provider’s actual charge may exceed Our Allowed Amount. You must pay the difference between Our Allowed Amount and the Non-Participating Provider’s charge. Contact Us at the number on Your ID card for information on Your financial responsibility when You receive services from a Non-Participating Provider.

Allowed Amount means the maximum portion of a billed charge

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 actual amount of charges for healthcare services, equipment, or supplies that are covered expenses under the terms of an insurance policy or health benefits plan.

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.