Allowed Amount
Updated July 20261 minute read
The allowed amount is the maximum price your insurance plan considers reasonable for a service. Out-of-network reimbursement percentages apply to this number — not to what you actually paid — which is why checks are sometimes smaller than expected.
Example: your PT charges $150, your plan's allowed amount for that service is $120, and your coinsurance is 70%. The plan reimburses 70% × $120 = $84, not 70% × $150. The gap between charged and allowed is yours.
Allowed amounts vary by plan and region, and insurers don't advertise them — but you can ask member services for the allowed amount for a specific CPT code before you start care. See the full math in out-of-network reimbursement, step by step.
This article is for education only and isn't medical advice. Always talk to a licensed clinician about your specific situation.