What is a reasonable and customary charge and how can it apply to me?
Every insurance company determines the level of reasonable and customary charges for each type of service. When you use PPO participating providers, there is an agreement between them and the insurance company as to their charges, and you will not be responsible for charges above reasonable and customary. However, when you go out-of-network, there is no protection against the provider charging more than the reasonable and customary charges allowed by the insurance company. These charges may be substantial. Charges in excess of reasonable and customary (sometimes also called usual and customary or maximum allowable) will be your responsibility, and these charges do not apply to the deductible or to your out-of-pocket limits.
