Limited policy

Insurance contract that gives coverage only to specific accidents or illnesses.
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A Policy providing Insurance against specified types of accidents or restricted in indemnity payments as contrasted with full coverage policies.

Limiting charge

Maximum amount a nonparticipating physician may legally charge a Medicare patient for services billed on nonassigned insurance claims. In the original Medicare plan, it is usually the highest amount of money a beneficiary can be charged for a covered service by doctors and other health care suppliers who do not accept assignment. The limiting charge is 15% over Medicare’s approved amount. The limiting charge only applies to certain services and does not apply to supplies or equipment. This was previously called a maximum allowable actual charge (MAAC) . Also referred to as billing limit or limiting fee charge .

Line item

Medical service or other item listed as a line entry on an insurance claim form or other computer-generated document. Usual data are date of the service, procedural code, service fee amount, and so on.

Line item denial

Insurance carrier or fiscal intermediary’s refusal to pay one or more of the line items on an insurance claim due to a technical error or because of insurance policy benefit issues. Denied line items must be appealed by the provider except for emergency department visits in which the patient died during a procedure categorized as an inpatient procedure. In that situation, the claim is resubmitted as an inpatient claim.