Reasonable and Customary Charge definition

Reasonable and Customary Charge means the actual fee charged by a dentist or a denture therapist for a service rendered or supply furnished but only to the extent that the fee is reasonable taking into consideration the following:

Reasonable and Customary Charge means the lesser of:

Reasonable and Customary Charge means a charge that does not exceed the usual level of charges for similar necessary medical treatment, services or supplies in the locality where it is received. SICKNESS means an illness or disease of the body which:

Examples of Reasonable and Customary Charge in a sentence

• We will determine the Reasonable and Customary Charge for the covered Medical Expense.

• For the services authorized by U P M C Health Plan that are provided by a Non-Participating Provider, the Reasonable and Customary Charge is the amount that UPMC Health Plan determines is reasonable for Covered Services pursuant to industry standards.

• Medical RepatriationIf the Covered Person dies while Covered under the Plan, We will pay for the Reasonable and Customary Charge incurred for embalming, and/or cremation and returning the body to his place of residence in his/her home country or country of regular domicile, subject to the Coinsurance, Deductible, Copayment, maximums and limits as stated in the Schedule of Benefits and subject to the Exclusions and Limitations provision.

• No more than the Reasonable and Customary Charge for the types of dental services shown in section C will be covered by the Dental Expense Benefits.

• A Non-Participating Provider may charge you the difference between the billed amount and the Reasonable and Customary Charge.

More Definitions of Reasonable and Customary Charge

Reasonable and Customary Charge means a charge in an amount consistently made by other vendors/providers for a given service in the same geographic area and which reflects the complexity of the service taking into account availability of experienced repair personnel, availability of parts, and the effort of the vendor/provider to repair the damaged vehicle (as measured by the ratio of total repair time to total time the vehicle is in the vendor/providers possession).

Reasonable and Customary Charge means the usual charge made for the covered dental expense, in the absence of coverage, but not more than the prevailing charge in the area where the expense is incurred.

Reasonable and Customary Charge means the usual charge of the provider for the service or supply, in the absence of coverage, but not more than the prevailing charge in the area for a like service or supply. A like service or supply is one of the same nature and duration, requires the same skill, and is performed by a provider of similar training and experience.

Reasonable and Customary Charge means the normal charge of the provider, in the absence of insurance, 1) for a medical service or supply, but not more than the prevailing charge in the area for a like service by a provider with similar training or experience, or 2) for a supply which is identical or substantially equivalent. Ingenix is used to determine Reasonable and Customary. The final determination of a Reasonable and Customary charge rests solely with the Company.

Reasonable and Customary Charge means the following:

Reasonable and Customary Charge. A charge shall be considered Reasonable and Customary to the extent that it does not exceed the general level of charges accepted by others of similar standing in the area where the charge is incurred, when furnishing like or comparable treatment, services or supplies to an individual of the same sex and of comparable age and income, for similar Illness or Injury. The term “area” means a county or such greater area as a is necessary to establish a representative cross section of persons or other entities regularly furnishing the type of treatment, services or supplies for which the charge was made. All determinations of “Reasonable and Customary” will be made by the Plan.

Reasonable and Customary Charge means a charge in an amount consistently made by other vendors/providers for a given service in the same geographic area, which reflects the complexity of the service taking into account availability of experienced personnel and/or availability of services or parts.