Customary Charges definition

Customary Charges means the amount CONTRACTOR normally or usually charges the 36 majority of its clients for a specified type of service, including the types of Psychiatric Inpatient 37 1 Hospital Services defined herein. CONTRACTOR’s customary charges shall be subject to review by the Department of Health Care Services.

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Customary Charges is defined in conformity with 42 USC § 1395f and the regulations promulgated pursuant thereto.

Customary Charges as defined in Section 2.12(c).

Examples of Customary Charges in a sentence

• The Medical Expenses incurred are Reasonable and Customary Charges for any procedure where such procedure is undertaken by an Insured Person as Day Care Treatment.

• Reasonable and Customary Charges The charges which: Are medically required for the treatment, supplies or medical service to treat an Insured Person's condition; Do not exceed the usual level of charges for similar treatment, supplies or medical services in the locality where the expenses are incurred, and Do not exceed the charges for treatment that would have been made if no insurance existed.

• Follow up Treatment in South Africa All Reasonable and Customary Charges incurred for Illness or Injury, resulting in hospitalisation, surgical or other diagnostic or remedial treatment given or prescribed by a qualified Medical Practitioner, dentist or optometrist in South Africa.

• Some Works-in-Progress may be reduced to a 50 percent payment of the Usual and Customary Charges.

• Emergency Medical Expenses All Reasonable and Customary Charges which at the sole discretion of AIG Travel are deemed medically necessary for Illness or Injury on an International Journey.

• IN-HOSPITAL PHYSICIAN VISIT - Reimbursement of the Reasonable and Customary Charges by a Physician for Medically Necessary visiting an in-paying patient while confined for a non-surgical disability subject to a maximum of 2 visits per day not exceeding the maximum number of days as set forth in the Schedule of Benefit.

• MONTHLY/ANNUAL OUT-PATIENT CANCER TREATMENT - If an Insured is diagnosed with Cancer as defined below, the Company will reimburse the Reasonable and Customary Charges incurred for the Medically Necessary treatment of cancer performed at a legally registered cancer treatment centre subject to the limit of this disability as specified in the Schedule of Benefit.

• ANAESTHETIST FEE - Reimbursement of the Reasonable and Customary Charges by the Anaesthetist for the Medically Necessary administration of anaesthesia not exceeding the limits as set forth in the Schedule of Benefit.

• ORGAN TRANSPLANT - Reimburses Reasonable and Customary Charges incurred on transplantation surgery for the Insured Person being the recipient of the transplant of a kidney, heart, lung, liver or bone marrow.

• PRE-HOSPITAL DIAGNOSTIC TESTS - Reimbursement of the Reasonable and Customary Charges for Medically Necessary ECG, X-ray and laboratory tests which are performed for diagnostic purposes on account of an injury or illness when in connection with a Disability preceding hospitalisation within 60 days preceding confinement in a Hospital and which are recommended by a qualified medical practitioner.

More Definitions of Customary Charges

Customary Charges as defined in Section 2.11(d).

Customary Charges means the standard amount a service provider bills on behalf of every patient treated.22 But a “customary” charge is not necessarily a “reasonable” charge that must be reimbursed in full by the insurer.23 “[T]he ‘customary fee’ is simply the cap on what health-care providers can charge, and is not, automatically, a ‘reasonable’ charge requiring full reimbursement under § 3107.”24 The service provider bears the burden of proving both the customariness and the reasonableness of its charges.25

Customary Charges means the amount CONTRACTOR normally or usually charges

Customary Charges means (1) the charges listed in an established charge schedule (if the institution has only a single set of charges applied to all patients), or (2) the most frequent or typical charges imposed (if the institution uses more than one charge for a single service). However, in order to be considered the “customary charge,” a charge would have to be one that was actually collected from a substantial number of individuals. A charge set up in name only, perhaps primarily to avoid the effect of this provision, is not intended to determine Medicare reimbursement.