Billed Charges
Billed charges is the amount originally billed for medical services, also referred to as "Gross Charges," which is often discounted based on insurance contracts or self-payment arrangements.
What is are Billed Charges?
Billed charges is the non-discounted amount that a healthcare provider invoices a patient for services rendered. These are the amounts initially presented to the patient or their insurance company before any adjustments, discounts, or payments are applied. This term is distinct from "allowed charges," which represents the amount the provider will actually be paid by the insurance company.
Billed charges are important for understanding the initial cost of care. For patients with out-of-network insurance or other types of coverage like worker's compensation, they may be billed the full charges. While an explanation of benefits (EOB) shows the total billed charges, it is not a bill itself but rather an itemization of how much a health plan covers and what the patient will eventually owe.
What is the difference between are Billed Charges and Allowed charges?
Billed charges are the non-discounted, initial amounts invoiced by a healthcare provider for services. Allowed charges represent the final, usually lower, amount the insurance company agrees to pay the provider.
Billed charges are the initial, non-discounted amount the provider invoices before adjustments, discounts, or payments are applied.
Allowed charges are the amount the provider will actually be paid by the insurance company.
Patients with out-of-network insurance or worker's compensation may be billed the full Billed charges.
What are examples of are Billed Charges?
A hospital charges $10,000 for a surgery before any insurance adjustments or discounts are applied.
A patient with out-of-network insurance receives an invoice for the full $500 cost of a specialist visit because their insurance company does not have a negotiated rate with that provider.
An Explanation of Benefits (EOB) from an insurance company lists total billed charges of $2,000 for a diagnostic test, even though the patient will only owe a smaller copayment after the insurance pays its portion.
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