Reasonable & Customary charges definition
Reasonable & Customary charges means the charges for services or supplies, which are the standard charges for the specific provider and consistent with the prevailing charges in the geographical area of identical or similar services, taking into account the nature of the illness/injury involved.
Reasonable & Customary charges means a charge which a) is charged for medical treatment of Illness or Injury, supplies or medical services that are medically necessary, as certified by the Medical Practitioner for the treatment of such Illness or Injury; b) do not exceed the level of charges that are charged on average basis, for similar medical treatment, supplies or medical services in the locality where the expenses are incurred when compared with comparable providers only ; and c) do not include charges that would not have been made if no insurance existed.
Reasonable & Customary charges. The average amount charged in respect of valid services or treatment costs, as determined by our experience in any particular country, area or region and substantiated by an independent third party, being a practising surgeon/physician/specialist or government health department. Related Condition: Any injuries, illnesses or diseases are related conditions if we, on general advice, determine that one is a result of the other or if each is a result of the same injury, illness or disease.