Reasonable and Customary Charges
The terms "reasonable, usual and customary" refer to charges made by your health insurance provider for a given medical service. A charge is considered reasonable, usual and customary if it matches the general prevailing cost of that service within your geographic area, which is calculated by your insurance company. The insurance company then uses this information to determine how much it's willing to pay for a given service in your area. This means that if your doctor charges above the reasonable and customary charge, you may have to pay the remainder.
This explanation may leave you with a lot of questions. How are these charges determined? How can you find out what your insurance company's reasonable and customary charges are? What insurance plans can you find these types of charges in? And finally, what are your options when you're charged above these reasonable and customary charges?
All of these questions will be answered in this article. First, let's find out how a charge is deemed reasonable and customary in the first place.