What does a company mean by usual and customary charges?
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. For example, if your policy pays at the 80th percentile of usual and customary, that means they pay based upon the fee charged by 80% of the providers for that particular service within the geographical area. Although usual and customary provisions are explained within the policy, companies seldom disclose the percentile at which they pay usual and customary. For more information, please see Fact Sheet entitled Usual and Customary Fees.
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. For example, if your policy pays at the 80th percentile of usual and customary, that means they pay based upon the fee charged by 80% of the providers for that particular service within the geographical area. Although usual and customary provisions are explained within the policy, companies seldom disclose the percentile at which they pay usual and customary.
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