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Cost FAQs

WHAT ARE RECOGNIZED CHARGES?

Recognized charges (formerly known as reasonable and customary charges) are the charges most often made for a given health care service or supply in a geographical area. Benefits paid by the LM HealthWorks Plan for out-of-network care are based on recognized charges.  Recognized charges take into account pertinent factors including:

  • The complexity of the service,
  • The range of services provided, and
  • The prevailing charge level in the geographic area where the provider is located and other geographic areas having similar health care cost experience.

It is important to note that you will be responsible for any costs in excess of the recognized charges if you receive care from an out-of-network provider. 

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