billedrate

The billed rate is the price a healthcare provider originally submits for a service on a claim. It is often referred to as the charge or chargemaster rate and represents the listed price before any adjustments, discounts, or negotiations with a payer.

In practice, the billed rate is not usually the amount paid. Payers enter into contracts with providers that specify a negotiated or allowed amount for each service. The insurer typically pays the allowed amount, and any difference between the billed rate and the allowed amount is called a contractual adjustment or discount. Patients may still owe a portion of the cost—their responsibility is frequently based on the allowed amount and the plan rules for deductible, coinsurance, and copayment. In some cases, especially with out-of-network providers, balance billing can occur, leading to charges higher than the amount paid by the insurer.

Price transparency efforts aim to reveal billed rates as part of the total cost of care, though the billed rate alone does not determine final charges. Hospitals and other providers maintain chargemaster lists that feed the billed rate used in claims.

Beyond healthcare, the term billed rate can describe the price stated on an invoice for any service or product before discounts or rebates. Understanding the distinction between billed rate, negotiated/allowed amounts, and patient responsibility helps interpret medical bills and pricing comparisons.