Reasonable and Customary is defined by our health plan as "those charges made for medical services and/or supplies essential to the care of a Covered Person which will be considered reasonable and customary if they are the amount normally charges by the Provider for similar services and supplies and do not exceed the amount ordinarily charged by most providers for comparable services and supplies in the locality where the services or supplies are received."

Most dental insurance plans have usual, customary and reasonable fees. Find out what usual, customary and reasonable (UCR) means and how it could affect your dental insurance plan. See similar questions...

Because you can go anywhere you'd like for services, chances are the insurance company won't have a contract with the doctor or provider of services you decide to go to. Therefore, the insurance company has no control over the amount of money your doctor or provider is billing for their services. The insurance company has to control costs somehow. What they (the insurance companies) do is establish usual, customary and reasonable charges for any kind of services you might receive. See similar questions...

Insurers collect data from their own experience or from other sources reflecting the fees charged by health care providers in a particular geographic area for a specific service or procedure. Generally, the data is collected by zip code area or other regional basis. The data must be updated every six months and can be no more than 18 months old. See similar questions...

Usual, customary, and reasonable (UCR) charges for covered services are determined by using the usual level of charges made by the majority of dentists in the same geographic area for the same service. If your dentist's fee is lower than the UCR charge, the plan will pay benefits based on the actual fee. If the fee is higher, the plan will pay benefits based only on the UCR charge, and you are responsible for any amount above the UCR limit. See similar questions...

Usual, Reasonable and Customary means with respect to fees or charges, fees for medical services or supplies which are usually charged by the provider for the service or supply given and the average charge for the service or supply in the locality in which the service or supply is received; whichever is less, or with respect to treatment or medical services, treatment which is reasonable in relationship to the service or supply given and the severity of the condition. See similar questions...

Usual, customary and reasonable charge refer to fees charged by an individual/institution that are consistent with the going rate in a given region or geographical area. See similar questions...

Reasonable and customary (R&C) is the dollar amount allowed for a particular service. The reasonable and customary amount for charges is determined using your geographic area. See similar questions...

When receiving care from a network doctor or hospital, you will not have to be concerned about being billed for charges that are considered about "reasonable and customary." If you receive care from a non-network doctor or hospital who charges rates above what is "reasonable and customary," you are responsible for the extra charges. Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, See similar questions...

The Student Health Plan (SHP) is an insurance program you can enroll in as a student at the School of Public Health. You are not obliged to sign up for SHP but, if you do not, you must be enrolled in a comparable health insurance program. Contact the Business Office to find out what plans are comparable to SHP. SHP covers 80% of most services and prescriptions and allows you to see the physician of your choice. SHP coverage requires that you pay a $100/person ($300/family) annual deductible. See similar questions...

Reasonable and Customary Fees are the average fees charged by a particular type of health care professional, within a certain geographic area. This fee is the amount of money that an insurance company will approve for a specific procedure or test. If the fee charged is higher than the approved fee, then the individual receiving the service is required to pay the difference. See similar questions...

A "reasonable and customary charge" is the charge typically made by physicians or suppliers of medical services, medicines and supplies within a specific geographic area. See similar questions...

Under a UCR (Usual, Customary and Reasonable) plan, patients are usually allowed to see the dentist of their choice. These plans pay an established percentage of the dentist’s fee or pay the plan sponsor’s “customary” or “reasonable” fee limit, whichever is less. The limits may or may not reflect the fees that area dentists charge. It may also be noted on your bill the fee that your dentist has charged you is higher than the reimbursement levels of UCR. See similar questions...

Usual and customary, also called reasonable and customary, means the fee charged by most of the providers in a given geographical area for a particular service. Insurance companies may subscribe to an independent service which periodically surveys providers in a given area, or they may use their own claims experience to establish usual and customary allowances. Most companies pay claims based upon a percentile of the usual and customary fee schedule. See similar questions...

You can enroll in our plan within 30 days of a qualifying event (loss of other coverage) regardless of our enrollment deadline. You must supply written proof that your other coverage has terminated through a qualifying event. See similar questions...

Insurance Companies have a set allowable rate for procedures according to the provider’s zip code area. Any amount over that rate could be denied by your insurance as patient responsibility. Therefore, you would be responsible for that portion. Most insurances require authorization for inpatient care only, however some plans require pre-authorization for some procedures that we perform. See similar questions...