Examples of Allowable Charge in a sentence

Whenever any payment for Covered Services has been made by the Plan, in an amount that exceeds the maximum Benefits available for such services under this Benefit Plan or exceeds the Allowable Charge, or whenever payment has been made in error by the Plan for non-covered services, the Plan will have the right to recover such payment from the Plan Participant or, if applicable, the Provider.
If the amount that is billed for Covered Services by the Plan Participant’s Provider is less than the amount that the Plan Administrator has set for the Covered Service, the billed amount is the Allowable Charge and the Plan Administrator’s payment will be based on the billed amount.
After any applicable Dental Waiting Period and payment of any applicable Deductible Amount shown on the Schedule of Benefits, the Claims Administrator will pay the Coinsurance percentage for the Covered Services shown on the Schedule of Benefits, rendered by a Dentist, not to exceed the Allowable Charge, up to the Benefit Period Maximum, if any, as shown on the Schedule of Benefits.
When a Plan Participant uses a Non-Participating Provider, this Allowable Charge is used to determine the Plan Administrator’s payment for a Plan Participant’s Covered Services and the amount that the Plan Participant must pay for Covered Services.
Also, Participating Providers waive the difference between the actual billed charge for a Covered Service and the Allowable Charge, while Non-Participating Providers will not.

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 Xxxxx 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 Xxxxx Vision. Authorization (Authorized) – A determination by Xxxxx 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. 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. 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 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 Benefit Plan. Benefits are based on the Allowable Charge for Covered Services and the Schedules of Dental Benefits.

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. 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 a Member’s authorized representative to change an Adverse Benefit Determination made by Us. 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. 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 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.

Allowable Charge definition

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