What does the term "actual charge" refer to?

The term "actual charge" specifically refers to the amount billed by a physician or supplier for services rendered. This is the figure that appears on the billing statement and reflects the provider's charge before any discounts, adjustments, or insurance negotiations are applied.

Understanding that "actual charge" is a direct reflection of what a healthcare provider charges helps clarify the financial interactions between providers and patients, as well as between providers and insurance companies. It is important to differentiate this from other terms like average price or Medicare reimbursement, which refer to different aspects of healthcare costs. The actual charge is the starting point for determining how much a patient may owe after insurance benefits are applied.