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

For non-Emergency Services performed by Non-Participating Providers during Your Visit at a Participating Facility, and for Emergency Services provided by a Non-Participating Provider or Non-Participating Emergency Facility, the Recognized Amount is used to calculate Your cost-share requirements, including Deductibles, Copayments, and Coinsurance.
The amount that is applied to the Annual Deductible is calculated on the basis of the Allowed Amount or the Recognized Amount when applicable.
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.
Amounts which you are required to pay as shown below in the Schedule of Benefits are based on Eligible Expenses or, for specific Covered Health Services as described in the definition of Recognized Amount in Section 14, Glossary.
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 or out-of-Network non- Physician should 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.

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 (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 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. 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.