What are usual customary and reasonable charges?
Most Health plans have established usual customary and reasonable procedures for a particular accident or illness. These usual customary and reasonable procedures also have acceptable costs. If your Doctor performs tests the insurance company does not include in the usual customary and reasonable procedures, you will be charged for them. Similarly, if costs are above the usual customary and reasonable charges you may also be billed for the amount not covered by your insurance. Q : The doctor charged $3,500.00 for a medical procedure and insurance company only paid $2,000.00 because they say this is the UCR amount. Can they do this and do I owe the difference? A: Unfortunately, the answer is yes. Medical fees do not always follow “rational” patterns and medical providers are free to charge according to their own fee schedule. To ensure rate stability and uniformity of coverage, UCR fees are established and serve as the maximum allowable charge for all insureds. Q : Is there anything I c
