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Allowed Amount

The highest dollar amount your health insurance plan will pay for covered health care services. This may also be called “eligible expense,” “payment allowance” or “negotiated rate.” If your provider charges more than the allowed amount, you may have to pay the difference. Your provider can only charge more than the allowed amount if they are outside of your health plan’s network. If an out-of-network provider charges more than the payment allowance, you may have to pay the difference. See also balance billing.