The Allowed Charge is the amount GHI will reimburse you for covered services rendered by non-participating Providers.
The lesser amount of the actual charge or the maximum allowable payment -MAP, or the patient contract indemnified payment limitation amount.
The amount Medicare or your insurance company approves for payment to a physician for a service rendered. Typically, Medicare pays 80 percent of the approved charge and the patient pays the remaining 20 percent.
Individual charge determined by a carrier for a covered SMI medical service or supply.
This is the amount Medicare approves for payment to a physician, but may not match the amount the physician gets paid by Medicare (due to co-pay or deductibles) and usually does not match what the physician charges patients. Medicare normally pays 80 percent of the approved charge and the beneficiary pays the remaining 20 percent. The allowed charge for a nonparticipating physician is 95 percent of that for a participating physician. Non-participating physicians may bill beneficiaries for an additional amount above the allowed charge. These rates are published by the HCFA intermediary in each state.