Reasonable and Customary (R&C) and Usual Customary and Reasonable (UCR) Charges and Balance Billing What Does This All Mean?
These are all terms that apply specifically to dental plan claims. CIGNA utilizes a national database that tells you what 8 out of 10 providers within a certain area are charging for services. This national database takes into account that the cost of living and cost of services will vary by geographic region. CIGNA will only pay the reasonable and customary reimbursement rate for that service. If a member happens to be using a particularly expensive provider that is charging more than the reasonable and customary fees, then the member will be responsible for the deductible and coinsurance amount PLUS any charges in excess of R&C. R&C (Reasonable and Customary) Example: A dentist is charging $500 for a root canal. Your benefits have a $50 deductible and 80% coinsurance. If 8 out of 10 dentists in your local area are only charging $400 for root canals, then $400 is the R&C amount that CIGNA is going to base payment on for your dental services no matter how much your dentist charges you.
Related Questions
- Plans say they pay for usual, customary, and reasonable (UCR) or reasonable and customary (R&C) charges. What does UCR and R&C mean and how is it determined?
- Plans say they pay for Usual, Customary & Reasonable (UCR) or Reasonable & Customary (R&C) charges. What does UCR or R&C mean and how is it determined?
- Reasonable and Customary (R&C) and Usual Customary and Reasonable (UCR) Charges and Balance Billing What Does This All Mean?
