What and how much are reasonable and customary limits?
Reasonable and customary limits are the amount your health plan will pay based on the range of usual fees for comparable medical services in a geographic area. If your provider charges more than the reasonable and customary limit, you will be responsible for paying the difference. Ranges can vary based on whether you have a medical condition that warrants non-standard therapy. Like other health benefit providers, Pacific Blue Cross reviews and uses reasonable and customary limits on a continual basis to determine maximum eligible amounts for health care services and supplies covered by your plan. Smart shopping for health care products and services helps members by reducing out of pocket expenses and helps employers reduce benefit plan costs. View reasonable and customary limits for paramedical coverage (pdf).
