What is a reasonable and customary charge and how does that charge affect me as a consumer?
Reasonable & Customary charges are guidelines developed by an independent source and used by insurance companies. These guidelines help to assure that the fees which providers are charging are reasonable for the service provided in their geographic area. Aetna utilizes the 90th percentile of Reasonable & Customary charges for most the UMDNJ student plan.
Reasonable and Customary (R&C) charge means the normal and customary charge of the provider, incurred by the Covered Person, in the absence of insurance for a service or supply, but not more than the prevailing charge in the area. If you are treated by an out-of-network provider, there may be a difference between what they are charging and what is considered Reasonable & Customary. You would be responsible for that difference.
