Allowable Charge definition
Allowable Charge means the amount from which the carrier's payment to a provider for any
Allowable Charge. The lesser of the billed charge or the amount established by Claims Administrator as the greatest amount this Contract will allow for a specific service covered under the terms of this Contract. Appeal – A written request from a Member or authorized representative to change an Adverse Benefit Determination made by the Company. Amalgam – A durable metal alloy comprised of silver, copper, tin and mercury, used in dental restorations. Authorization (Authorized) – A determination by Claims Administrator regarding a dental healthcare service or supply which, based on the information provided, satisfies the clinical review criteria requirement for Medical Necessity, appropriateness of the healthcare setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Additionally, an Authorization is not a determination about the Member's choice of Provider. Beneficiary – A person designated by a participant, or by the terms of a health insurance Benefit Plan, who is or may become entitled to a Benefit under the plan. Benefit(s) – Coverage for dental services, treatments or procedures provided under this Contract. Benefits are based on the Allowable Charge for Covered Services and the Schedules of Dental Benefits.
Allowable Charge. The lesser of the billed charge or the amount established by UCD as the greatest amount this Contract will allow for a specific service covered under the terms of this Contract. Appeal – A written request from a Member or authorized representative to change an Adverse Benefit Determination made by the Company. Amalgam – A durable metal alloy comprised of silver, copper, tin and mercury, used in dental restorations. Authorization (Authorized) – A determination by UCD regarding a dental healthcare service or supply which, based on the information provided, satisfies the clinical review criteria requirement for Dental Necessity, appropriateness of the healthcare setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Additionally, an Authorization is not a determination about the Member's choice of Provider. Beneficiary – A person designated by a participant, or by the terms of a health insurance Benefit Plan, who is or may become entitled to a Benefit under the plan. Benefit(s) – Coverage for dental services, treatments or procedures provided under this Contract. Benefits are based on the Allowable Charge for Covered Services and the Schedules of Dental Benefits.
Examples of Allowable Charge in a sentence
Reimbursements for services rendered by a Non-Participating Provider will be based on Our Allowable Charge and will be paid under the same limits, rules and policies that We would have applied to claims for services rendered by a Participating Provider.
The Allowable Charge depends on the specific Provider from whom a Member receives covered services.
We base Our payment of Benefits for the Member’s covered services on an amount known as the Allowable Charge.
Whenever any payment for Covered Services has been made by Us in an amount that exceeds the maximum Benefits available for such services under this Contract or exceeds the Allowable Charge, or whenever payment has been made in error by Us for non-Covered Services, We will have the right to recover such payment from You or, if applicable, the Provider.
When payment for Covered Services has been made by the Company in an amount that exceeds the maximum Benefits available for such services under this Benefit Plan, or when payment exceeds the Allowable Charge or has been made in error by the Company or for non-Covered Services, the Company will have the right to recover such payment from the Member or, if applicable, the Provider.
More Definitions of Allowable Charge
Allowable Charge means the amount from which the carrier's payment to a provider for any covered item or service is determined before taking into account any cost-sharing arrangement.
Allowable Charge. The lesser of the billed charge or the amount established by Claims Administrator as the greatest amount this Benefit Plan will allow for a specific service covered under the terms of this Benefit Plan. Appeal – A written request from a Member or authorized representative to change an Adverse Benefit Determination made by the Company. Amalgam – A durable metal alloy comprised of silver, copper, tin and mercury, used in dental restorations. Annual Deductible – The dollar amount that each Member must pay out of their own pocket for Covered Services within each Benefit Period before any Benefits are paid under this Benefit Plan. The Annual Deductible will be shown in the Schedule of Dental Benefits, which may be waived for certain services. Authorization (Authorized) – A determination by Claims Administrator regarding a dental health care service or supply which, based on the information provided, satisfies the clinical review criteria requirement for Medical Necessity, appropriateness of the health care setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Additionally, an Authorization is not a determination about the Member's choice of Provider. Beneficiary – A person designated by a participant, or by the terms of a health insurance Benefit Plan, who is or may become entitled to a Benefit under the plan. Benefit(s) – Coverage for dental services, treatments or procedures provided under this Benefit Plan. Benefits are based on the Allowable Charge for Covered Services and the Schedules of Dental Benefits.
Allowable Charge. The lesser of the billed charge or the amount established by ▇▇▇▇▇ Vision as the maximum amount allowed for all Provider services covered under the terms of this Benefit Plan. Appeal – A written request from a Member or authorized representative to change an Adverse Benefit Determination made by ▇▇▇▇▇ Vision. Authorization (Authorized) – A determination by ▇▇▇▇▇ Vision that, based on the information provided, a Benefit satisfies the clinical review criteria requirement for Medical Necessity, appropriateness of the healthcare setting, or level of care and effectiveness. An Authorization is not a guarantee of payment. Benefit(s) – Coverage for the benefits as described in Article IV and the Schedule of Vision Benefits. Benefits provided by the Company are based on the Allowable Charge.
Allowable Charge means the lesser of the amount payable under the terms of the pharmacy’s contract with the PBM for a covered medication or the cash price inclusive of all applicable customer discounts which a cash paying customer of the pharmacy pays for a covered medication.
Allowable Charge. Has the same meaning as defined in your EOC. See “Appendices - Definitions.” Brand Name Drug: A prescription drug that has been patented and is produced by only one manufacturer. Cost Share: Has the same meaning as defined in your EOC. FDA: The United States Food and Drug Administration.
Allowable Charge. An amount that is not more than the allowance for the service or supply as determined by Us, based on a standard which is most often charged for a given service by a Provider within the same geographic area.
Allowable Charge means the charge which is the lesser of: 1) The actual charge, 2) the negotiated charge that a Preferred Provider has agreed to accept for service, or 3) the Usual and Customary Charge for a covered service.