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 ?
Smith would have had to pay only $220 (20% of the approved charge of $1,100 that Medicare does not pay).
Under the first method, the patient will receive 80% of what the contractor determines is an approved charge for the services after the $155 (in 2010) deductible--regardless of the actual charge.
Those services for which the allowed charges were based on an "other" source (7.2 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.
In October, a federal grand jury approved charges on former Trump aides.
It would empower Nepra to establish district-level complaint offices to hear and decide on complaints regarding overbilling, non-compliance of instructions respecting metering and collection of approved charges, disconnection in case of non-payment of charges, electric power theft, and use of energy for purposes other than for which it was supplied.
The clause relates to 'offices of complaints regarding over-billing etc', the authority may establish district-level complaint offices to hear and decide complaints regarding over-billing, non-compliance of instruction respecting metering and collection of approved charges, disconnection in case of non-payment of charges, electric power theft and use of energy for purposes other than for which it was supplied'.
They also approved charges for care alarms which will mean a PS1m boost to council coffers.
The Maritime Port Authority (MPA) of El Salvador has approved charges for this service, while Costa Rica adapts some rules to facilitate the transaction."
It added that approved charges remained the same within 2013.
This included information on total approved charges; primary care incentive payments awarded to NPs and CNSs; bonuses for high-quality and electronic prescribing awarded to APRNs in each of the four roles; and also Medicaid incentive payments to NPs and CNMs for electronic health record installation and use.