When a provider bills you for the difference between the provider's charge and the allowed amount. For example, if the provider's charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. A preferred provider may not balance bill you for covered services.
As you explore our site, you may come across an unfamiliar word or term. We've developed a glossary that we hope will help you.
Services and supplies a health plan pays for. The term also refers to the amount a health plan allows.
Document that explains the benefits for self-funded (ASO) group subscribers. This is not the same as a Summary Plan Description (SPD) or a Plan Document.
The period of time a health plan will pay for covered benefits. Benefit periods are usually one year. They don't always reflect a calendar year.
A teleprocessing system that allows any Blue Cross and Blue Shield Plan to make available to other Blue Cross and Blue Shield Plans (in-or out -of-state) the same discounts they have negotiated with providers for their own customers.
A drug manufactured by a pharmaceutical company which has chosen to patent the drug's formula and register its brand name.