Most health insurance plans will set something called an allowable cost. That’s the amount that the insurance is willing to cover for a certain procedure, service, or test. The allowable cost may not be the full amount that the doctor is billing for. This means you may need to pay the difference.
Have questions about an allowable cost for a particular procedure? Check with your insurance before you schedule a service.
References
Capital District Physicians' Health Plan, Inc. (n.d.). Understanding health insurance terms.
Healthcare.gov. (n.d.). Allowed amount.
Healthcare.gov. (n.d.). Balance billing.
MedlinePlus. (2022). How to choose a health plan.
Why trust our experts?
Written by:
Hilary WeissmanHilary Weissman has been a health writer for the past 6 years. She was a senior copywriter at WW (Weight Watchers) before joining GoodRx and was also a copy editor in S&P Global’s structured finance ratings group for 3 years prior.
Reviewed by:
Sanjai Sinha, MDSanjai Sinha, MD, is a board-certified physician with over 20 years of experience. He specializes in internal medicine.
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