Definition
The maximum amount your insurance plan will pay for a covered service, based on negotiated rates with in-network providers. Also called the eligible expense, payment allowance, or negotiated rate. You are responsible for any difference between the billed amount and allowed amount only if the provider is out-of-network.
Related Terms
- CPT Code
Current Procedural Terminology code — a standardized 5-digit numeric code used t...
- ICD-10 Code
International Classification of Diseases, 10th Revision — a standardized code sy...
- Balance Billing
When an out-of-network provider bills you for the difference between their bille...
- Chargemaster
A hospital's comprehensive list of prices for every item and service, from aspir...
- No Surprises Act
A federal law effective January 2022 that protects patients from surprise medica...
Understanding healthcare terminology helps you communicate more effectively with providers and make informed decisions about your care. Use our procedure cost database to find fair prices for any medical service.