Reasonable & Customary

A charge is considered reasonable, usual and customary if it matches the general prevailing cost of that service within your geographic area.

A reasonable and customary fee is the amount that your health plan determines is the normal range of payment for a specific health-related service or medical procedure within a given geographic area. However, if the charges for the medical procedure exceed the amount your insurance company deem to be ‘reasonable & customary’ then you will have to pay the difference.

The majority of insurance companies will have approved panels of doctors, hospitals and medical institutions who comply with their pricing protocols.  Therefore, you should never experience any problem with claim shortfalls as long as you select your requirement from the approved list.

If you have any doubts or concerns or require any further information, please do not hesitate to contact one of our friendly team to discuss.