Recognized Amount definition

Recognized Amount means, for purposes of this Amendment only, an amount determined pursuant a state law that provides a method for determining the total amount payable for the item or service (if applicable); or, if there is no state law that provides a method for determining the total amount payable for the item or service, the lesser of the Qualifying Payment Amount or billed charges.

Recognized Amount means, except for Non-Network air ambulance services, an amount determined under an applicable all-payer model agreement, or if unavailable, an amount determined by applicable state law. If no such amounts are available or applicable and for Non-Network air ambulance services generally, the Recognized Amount shall mean the lesser of a Provider’s billed charge or the Qualifying Payment Amount.

Recognized Amount means, with respect to an

Examples of Recognized Amount in a sentence

• SAMPLE Amounts which you are required to pay as shown below in the Schedule of Benefits are based on Allowed Amounts or, for specific Covered Health Care Services as described in the definition of Recognized Amount in the Policy, Recognized Amounts.

• Co-insurance is the amount you pay (calculated as a percentage of the Allowed Amount or the Recognized Amount when applicable) each time you receive certain Covered Health Care Services.

• For Ancillary Services, non-Ancillary Services provided without notice and consent, and non- Ancillary Services for unforeseen or urgent medical needs that arise at the time a service is provided for which notice and consent has been satisfied, you are not responsible, and an out-of-Network Physician may not bill you, for amounts in excess of your applicable Co-payment, Co-insurance or deductible which is based on the Recognized Amount as defined in the Policy.

• Ground Ambulance: 40% Yes Yes Allowed Amounts for Air Ambulance transport provided by an out-of- Network provider will be determined as described below under Allowed Air Ambulance: 40% Yes Yes Amounts which you are required to pay as shown below in the Schedule of Benefits are based on Allowed Amounts or, for specific Covered Health Care Services as described in the definition of Recognized Amount in the Policy, Recognized Amounts.

• If you choose to stay in the out-of-Network Hospital after the date we decide a 40% Yes Yes SAMPLE Amounts which you are required to pay as shown below in the Schedule of Benefits are based on Allowed Amounts or, for specific Covered Health Care Services as described in the definition of Recognized Amount in the Policy, Recognized Amounts.

More Definitions of Recognized Amount

Recognized Amount means: (1) an amount determined by reference to an applicable All-Payer Model Agreement under section 1115A of the Social Security Act; (2) if there is no applicable All-Payer Model Agreement, an amount determined by reference to a specified state law; or (3) if there is no applicable All-Payer Model Agreement or specified state law, the lesser of the amount billed by the provider or facility or the QPA.

Recognized Amount means the lesser of the amount

Recognized Amount means, for purposes of this section only, an amount determined pursuant a state law that provides a method for determining the total amount payable for the item or service (if applicable); or, if there is no state law that provides a method for determining the total amount payable for the item or service, the lesser of the Qualifying Payment Amount or billed charges. “visit” includes, for purposes of this section only, covered items and services provided as part of nonemergency services furnished by a Non-Participating Provider, regardless of whether the Non-Participating Provider is present at a Participating Facility when furnishing the covered items or services.

Recognized Amount means the amount which the Copayment, Coinsurance and any applicable CYD, is based on for the below Covered Services when provided by Non-Plan Providers. The amount is based on either:  Applicable state law, or  The qualifying payment amount as determined under applicable law for the following Covered Services: o Non-Plan Emergency Covered Services.

Recognized Amount means (in order of priority) one of the following:

Recognized Amount means the lesser of the amount initially billed by the provider or the qualifying payment amount.

Recognized Amount. A dollar amount that serves as a basis for calculating a consumer’s cost sharing under the No Surprises Act for certain items and services. 🞅 In states with All-Payer Model Agreements, the recognized amount is the amount that the state approves under the All-Payer Model Agreement for an item or service. 🞅 In states with specified state laws (and no All-Payer Model Agreement), the recognized amount is the amount determined by the state law. 🞅 In states without an All-Payer Model Agreement or applicable state law, the recognized amount is either the amount billed by a provider or facility for an item or service or the Qualifying Payment Amount, whichever is lower. • Self-Insured Employer Health Plan – A self-insured (or self-funded) employer plan is a form of health care coverage offered by employers to their employees. This is a type of health plan that is usually offered by larger companies where the employer itself takes on the responsibility of paying employees’ and dependents’ medical claims. These employers can contract with a third-party administrator for services such as enrollment, claims processing, and managing provider networks, or they can self-administer these services. Self-insured plans are regulated by the federal government and generally are not subject to state insurance laws. • Self-Pay – When a consumer has health coverage but is not seeking to have claims submitted to their plan or insurance for items or services, and instead plans to pay for the items or services out of pocket. • Surprise Bill (also called a Surprise Medical Bill) – An unexpected balance bill for certain types of out-of- network costs that a consumer’s health insurance didn’t cover.