Insurance and network
Reimbursement rate
A reimbursement rate is the amount an insurer agrees to pay for a procedure, which may differ from the fee the practice normally charges.
HealthCare.gov defines the allowed amount as the maximum amount a plan will pay for a covered health care service. The site notes it may also be called an eligible expense, payment allowance or negotiated rate.
For an in-network dentist, the contract sets the rate for each procedure. If a provider charges more than the allowed amount, the patient may have to pay the difference when the contract allows it.
A rate lower than the usual fee leads to a write-off. Owners compare rates with their cost to deliver care when they consider PPO participation. See also dental PPO.