Approved charge


Also found in: Medical.

Approved Charge

In some health insurance plans, the amount that the insurer will pay for a medical procedure. Some insurers will only pay for medical procedures up to the approved charge. If the amount the physician or hospital bills exceeds the approved charge, the policyholder is responsible for paying it. See also: Coinsurance.

Approved charge.

With traditional fee-for-service health insurance, the insurance company sets an approved or allowable amount for each medical procedure or office visit.

If your bill exceeds the approved charge, the difference between the approved charge and the claim that's submitted to the insurance company for reimbursement is considered an excess charge. You are responsible for that amount in addition to a percentage of the approved charge.

Medicare establishes approved charges for medical procedures and office visits. If you participate in Original Medicare, there's a legal limit on what a doctor, laboratory, or other medical provider can charge in excess of the approved amount.

References in periodicals archive ?
2 percent of total) were excluded from the estimates because a CPR price equal to the approved charge was not available.
Instead of paying 20 percent of the Medicare approved charge, Mutual of Omaha pays 30 percent, thus, in effect, providing funds that can be used to pay for some, if not all, excess charges.
nTelagent's solution returns the appropriate approved charge, deductible, and co-pay or coinsurance - according to the payer's contracted rate - in a matter of seconds, all on the front end.
Thus, while counts of services and approved charges were computed within months following the end of a year, the reported persons served data often lagged by several years.
Local media in California reported that a key prosecution witness, Colonel John Ewers, had also served as a legal adviser to the marine general who approved charges against Chessani.
He both proposed and provided the blueprint for the latest approved charges, but is unapologetic to punters, who he benefited earlier in his career when spearheading the abolition of the 'under starter's orders' rule.
The STF has approved charges against all 40 people accused by federal prosecutors of funneling bribes or taking them.
The Civil Aviation Department has reportedly approved charges by Air Canada, KLM Royal Dutch Airlines and six mainland Chinese carriers including Air China, China Eastern Airlines, China Northern Airlines, China Northwest Airlines, China Southern Airlines and Yunnan Airlines.
Medicare then pays 80 percent of all approved charges.
NPs who meet the volume threshold but do not document their e-prescribing will lose 1 percent of their approved charges for services provided to Part B patients during calendar 2012.
In minutes, registrars using nTelagent validate the patient's address, verify insurance, process medical necessity (where appropriate), determine approved charges for the patient based on service provider's contracts, and follow online scripts for discounts, payment terms and patient collections.
Patient admission information will be provided to MedAptus via inbound interfaces from each hospital's MEDITECH system; completed, approved charges will be sent from MedAptus' RCA Engine to BIDHC's Ingenix CareTracker system for billing.