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Allowable Charges definition

Allowable Charges means a Contracted Provider’s billed charges for services that qualify as Covered Services.
Allowable Charges means the charges agreed to by the Preferred Provider Organization for specified covered medical treatment, services and supplies.
Allowable Charges means an amount, on a per claim basis, not to exceed the lesser of 23 100% of CalOptima’s fee-for-service reimbursement rates, less required co-payments or 100% of billed 24 charges, less required co-payments.

Examples of Allowable Charges in a sentence

  • Note the amount of Allowable Charges applied towards the Deductible also reduces the applicable benefit maximum by the same amount.

  • When claims are presented to the Insurer, the Allowable Charges will be applied towards the Deductible.

  • Once the Deductible has been satisfied, all Allowable Charges will be paid at the percentage listed on the Schedule of Benefits, up to the listed benefit maximum.

  • If the Plan has an Out-of-Pocket Maximum, once it is met the Plan will begin paying 100% of Allowable Charges for the remainder of insurance coverage, subject to the benefit maximums.

  • The secondary and subsequent plans will pay the balance due up to 100% of the total Allowable Charges.


More Definitions of Allowable Charges

Allowable Charges means the Usual and Customary charge for any Medically Necessary, Reasonable, and eligible item of expense, at least a portion of which is covered under a plan. When some Other Plan pays first in accordance with the Application to Benefit Determinations section, this Plan’s Allowable Charges shall in no event exceed the Other Plan’s Allowable Charges. When some Other Plan provides benefits in the form of services rather than cash payments, the reasonable cash value of each service rendered, in the amount that would be payable in accordance with the terms of the Plan, shall be deemed to be the benefit. Benefits payable under any Other Plan include the benefits that would have been payable had claim been duly made therefore.
Allowable Charges means the maximum amount to be allowed as Eligible Expense for services rendered by a Provider (Hospital or Physician) under contract with the Blue Cross or the Plan’s designated PPO provider. This amount will also apply to charges for services rendered by Physicians who are located in the geographic area serviced by the PPO but are not under contract with the PPO.
Allowable Charges or “Allowable Costs” means:
Allowable Charges means the costs of the actual Treatment(s) provided by a Veterinary Provider, subject to Policy limitations and exclusions, additional benefits as provided by the Policy and included on the Declarations Page, the Annual Maximum Benefit, or the Covered Incident Limit amount, except as excluded by the Policy.
Allowable Charges or “Allowable Costs” means a maximum of one hundred thirty percent 15 (130%) of the national Medicare Resource Based Relative Value Scale (RBRVS),less the required co- 16 payment as specified herein, for charges that are determined by the Intermediary to be attributable to 17 reimbursable services to Eligible Persons in accordance with all Agreements for the MSI Program.
Allowable Charges means 23 a. For Physicians - an amount not to exceed 100% of CalOptima fee-for-service 24 reimbursement rates, less required co-payments; provided, however, that COUNTY shall not be 25 obligated to the additional reimbursement which may be due to Physicians by CalOptima in accordance 26 with 42 CFR Part 438, 441 and 447. 27 b. For Other Providers – an amount not to exceed 100% of billed charges
Allowable Charges means the Combined Insurance Company of America allowance for a specified Covered Medical Expense of the Provider’s charge for the service, whichever