Allowance. is the amount a provider has agreed to accept for a covered health care service. Our allowance for a covered health care service may include payment for other related services. See How Your Covered Health Care Services Are Paid and the Summary of Benefits for services subject to copayments, deductibles (if any), and maximum benefits. For information about how we pay for health care services outside of our service area, please see Coverage for Services Provided Outside of the Service Area (BlueCard) section. When you receive covered health care services from a network provider, the provider has agreed to accept our allowance as payment in full. You will be responsible to pay your copayments, deductibles, and the difference between the maximum benefit and our allowance, if any. When you receive covered health care services from a non-network provider, you will be responsible for the provider’s charge. Our reimbursement will be based on the lesser of our allowance, the non-network provider’s charge, or the maximum benefit, less any copayments and deductibles, if any.
Appears in 15 contracts
Samples: Subscriber Agreement, Subscriber Agreement, Subscriber Agreement
