The allowed amount is the maximum amount an insurance plan recognizes for a covered service when calculating benefits. It may be lower than the therapist’s actual fee, so reimbursement is not necessarily calculated from the full session price.
For example, if a therapist charges $180 but the plan’s allowed amount is $120, the insurer will calculate its share using $120, not $180. The exact cost calculation depends on the plan, the member’s deductible and coinsurance, and any applicable limits. Ask the insurer how it determines the allowed amount for out-of-network therapy.