What are Reasonable and Customary Charges?
Reasonable and Customary Charges (R&C) are those charges that an insurance company deems to be reasonable for a given procedure. This varies by the service performed, the geographic location, and other factors, and has been predetermined for SHP. What does this mean to you? Our health insurance pays 80% of R&C for most services. If you recieve treatment or a referral for treatment through the UHS clinic, UHS will pay the remaining 20% of R&C on your behalf (you pay nothing). If you choose to go to an EHP-participating doctor, but without a referral from UHS, you will be responsible for paying the 20% portion of the R&C charges that remains after SHP pays their 80%. If you choose a doctor that does not participate with EHP, they may charge more than R&C. In this case, SHP still pays 80% of R&C, and you are responsible for paying the remaining charges in full (20% of R&C, PLUS the difference between R&C and your doctor’s charges). As an example, pretend you need a medical service perform
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?
- How are usual, customary, and reasonable charges determined for out-of-network medical benefits?
- What are usual customary and reasonable charges?
