Allowed amount

What does Allowed amount mean on a medical bill?

The allowed amount is the price your plan and the provider settled on for a service. It is the number every other number on the EOB is built from: the plan's payment, your share, and the write-off all come out of it. The charge printed on the provider's bill is a list price, and in network it is not what anyone actually receives. When a bill asks for more than your share of the allowed amount, the math, not the medicine, is the thing to question.

What does Allowed amount usually cost?

This is the real price of the service, and the charge above it is a starting point nobody in network pays. Out of network the plan sets the allowed amount on its own, so it can sit far below what was charged.

What should I watch out for with Allowed amount?

• A patient share that does not add up against the allowed amount on the EOB — ask the biller to show the math
• An allowed amount of nothing next to a full-charge bill, which usually means the claim was denied rather than priced
• Ask which fee schedule was used when the allowed amount looks far off from the plan's usual for that code