Actual Charge

What Does Actual Charge Mean?

An actual charge is the amount of money that a healthcare provider charges for a specific service or treatment.

Insuranceopedia Explains Actual Charge

Actual charges differ from allowable charges. If the actual charges exceed the allowable charges, the policyholder will be responsible for paying the excess amount out of pocket. Knowing how an actual charge fits alongside premiums, deductibles, co-pays, and coinsurance helps explain why two patients with the same plan can end up paying very different amounts for the same procedure. In certain cases, the costs exceeding the allowable charges can be significant, particularly with cosmetic or elective surgeries, which may carry high costs and limited or no coverage. If those gaps add up across a year, switching plans during open enrollment is often the most direct way to lower your overall health insurance costs.