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

• Out-of-Pocket Limit: The most You pay during a Plan Year in Cost-Sharing before We begin to pay 100% of the Allowed Amount for Covered Services.

• We will pay the remaining percentage of the Allowed Amount as Your in-network or out-of-network benefit as shown in the Schedule of Benefits section of this Contract.

• However, when the Allowed Amount for a service is less than the Copayment, You are responsible for the lesser amount.

• Coinsurance: Your share of the costs of a Covered Service, calculated as a percent of the Allowed Amount for the service that You are required to pay to a Provider.

• When You receive Covered Services from a Non-Participating Provider, in addition to the applicable Copayments, Deductible and Coinsurance described in the Schedule of Benefits section of this Contract, You must also pay the amount, if any, by which the Non-Participating Provider’s actual charge exceeds Our Allowed Amount.

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.