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: (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

• 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.

• For Ancillary Services received at certain Preferred Provider facilities on a non-Medical Emergency basis from Out- of-Network Provider Physicians, the Insured is not responsible, and the Out-of-Network Provider may not bill the Insured, for amounts in excess of the Insured’s Copayment, Coinsurance, or Deductible which is based on the Recognized Amount as defined in this Certificate.

• Provided for the purpose of preventing, evaluating, diagnosing or treating a Sickness or Injury.2. Medically Necessary.3. Specified as a covered medical expense in this Certificate under the Medical Expense Benefits or in the Schedule of Benefits.4. Not in excess of the Allowed Amount or the Recognized Amount when applicable.5. Not in excess of the maximum benefit payable per service as specified in the Schedule of Benefits.

• For Emergency Services provided by an Out-of-Network Provider, the Insured is not responsible, and the Out-of- Network Provider may not bill the Insured, for amounts in excess of the Insured’s applicable Copayment, Coinsurance, or Deductible which is based on the Recognized Amount as defined in this Certificate.

• 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.

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 (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, with respect to air

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. • Federal No Surprises Act Surprise Billing Protections The federal No Surprises Act contains various protections relating to surprise medical bills on services performed by Non-Participating Providers and Non-Participating Emergency Facilities. The items and services included in these protections (“Included Services”) are listed below.