In a claim, what does the term 'amount not covered' refer to?

The term 'amount not covered' in a claim refers specifically to services that are not included in a health plan. This means that any medical services provided to a patient that do not fall within the guidelines, benefits, or parameters set by their insurance policy will be categorized as not covered. As a result, the patient or the provider must bear the costs of these services out-of-pocket, as they are not reimbursable by the insurance.

Understanding this term is crucial for both patients and healthcare providers because it directly impacts billing, patient responsibilities, and potential out-of-pocket expenses. By knowing which services are not covered, patients can make informed decisions about their healthcare options and plan for any additional costs that may arise.