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:

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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 YOUR QUALIFIED DEPENDENT CHILDREN YOUNGER THAN AGE The amount payable is the Covered Percentage of the Reasonable and Customary Charge for the covered orthodontic services after satisfaction of the Lifetime Deductible, up to ?he Lifetime Maximum shown in the Summary of Benefits.
When the following terms are capitalized in this EOC, they will have the meaning set forth below: the billed amount for non-Plan providers (except that Physicians rendering Emergency Services, Hospitals which are not Plan Providers rendering any services, and non-contracting dialysis centers rendering any services when authorized by the Plan will be paid based on the Reasonable and Customary Charge, as defined).
The Court also affirmed its holding that Defendant “systematically breached its insurance policies containing the Reasonable and Customary Charge clause.” (Doc.
A "Reasonable and Customary Charge" is a charge for a service or supply that is: - the charge made for it by the supplier, or - the prevailing charge in the same area made by those of similar professional standing whichever is the lesser.

More Definitions of Reasonable and Customary Charge

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 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, with respect to fees charged by a medical practitioner or by a supplier of professional services, medicines, or supplies, the most common charge for similar professional services, medicines, or supplies within the area in which the charge is incurred, so long as those charges are reasonable. Reasonable and customary charges will be determined by us.

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 a charge which is usually made in the absence of this or any similar coverage, for a specific type of care, service or supply, based on representative fees and prices in the geographic area in which the charge for the care, service or supply was incurred.

Reasonable and Customary Charge means the general and popular range of charges incurred for offering similar or comparable treatment, service or item for a similar injury or disease by other service providers. The Company will not pay any charges that exceed reasonable and customary charges.