Approved charge

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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 ?
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.
For physicians who had solo practices and were also members of groups or clinics, approved charges for the group settings are not included.
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.
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.
However, because the Mutual of Omaha policy pays 30 percent rather than 20 percent of approved charges, patients who hodl this policy whose providers accept assignment will get an additional 10 percent of Medicare approved charges, which they can apply to whatever other costs they face.
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.
301 billion true-up balance, including adjustments for certain taxes, costs of securitization bond issuance and interest and other approved charges that have accrued since the end of August, the reference date for the true-up balance.
Preliminary data indicate that incurred approved charges billed to Part B carriers were about $33 billion in calendar year 1988, up about 10 percent from 1987.
In minutes, patient access staff using nTelagent validate patient address, verify insurance, perform medical necessity screening, determine estimated total and approved charges, and follow online scripts for discounts, payment terms and patient collections - all at point of service.
Patient pays $100 Annual Part B Deductible and 20% of Medicare- approved charges
Additionally, nTelagent's new Contract Calculator allows patient access staff to instantly and accurately perform some of the most complicated calculations related to patient financial accounts: what the approved charges are and the accurate patient coinsurance.
During the last two years, HEC has reimbursed tuition fee and other approved charges of more than 100,000 students of less developed areas amounting to Rs.