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: (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, with respect to an
Examples of Recognized Amount in a sentence
Except for air ambulance, your cost share is based on the Recognized Amount as described in the No Surprises Act and as set forth in the Glossary of Terms.
More Definitions of Recognized Amount
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 the lesser of the 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 means the lesser of the amount initially billed by the provider or the qualifying payment amount.
Recognized Amount means (in order of priority) one of the following:
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.
Recognized Amount means, with respect to an item or service furnished by a non-participating provider or non-participating emergency facility, an amount that is determined as follows: