What is the term for the difference between a doctor’s actual charge and the amount approved by Medicare?

The term for the difference between a doctor's actual charge and the amount approved by Medicare is known as an "excess charge." In the context of Medicare, this refers specifically to the amount that a healthcare provider may bill the patient over and above the Medicare-approved amount. Medicare typically sets a limit on what they will pay for services, and if a provider charges more than this limit, the extra amount constitutes the excess charge.

This distinction is important for patients to understand because it directly impacts their financial responsibility. If a patient receives care from a provider that does not accept Medicare's approved amount as full payment, they may be liable for the excess charge, which can lead to unexpected out-of-pocket expenses.

The other terms presented do not specifically refer to this scenario. Adjusted charges generally pertain to modifications made to charges for various reasons, out-of-pocket costs refer broadly to any expenses that are not reimbursed by insurance, and covered expenses refer to the services or costs that are eligible for reimbursement under a policy. Each of these lacks the specific focus on the discrepancy created when a provider's charges exceed what Medicare allows.