Usual and Customary Charges definition

Usual and Customary Charges means those comparable charges for similar treatment, services and supplies in the geographic area where treatment is performed.

Usual and Customary Charges means the average amount charged by most providers for comparable charges for similar treatment, services and supplies in the geographic area where treatment, service or supply is provided, as represented by the 80th percentile of the MDR database, which is organized by zip code.

Usual and Customary Charges means the amounts that other providers charge for similar treatment, services and supplies in the country, region and city where treatment is performed.

Examples of Usual and Customary Charges in a sentence

• All transportation arrangements must be made by the most direct and economical route and conveyance possible and may not exceed the Usual and Customary Charges for similar transportation in the locality where the expense is incurred.

• Benefits will not be paid in excess of the Usual and Customary Charges.

• The benefit is limited to the Usual and Customary Charges made by a Physician for the newborn child while Hospital confined as a result of the child's birth.

• The benefit is limited to Usual and Customary Charges for nursery care for the newborn Child while Hospital confined as a result of the Child's birth.

• The Outpatient Cost-to-Charge Ratio is a fixed percentage that is applied to HRC’s Usual and Customary Charges for Outpatient Services, based on charges filed with the DHCFP or successor agency.

More Definitions of Usual and Customary Charges

Usual and Customary Charges means: (1) With respect to fees or charges, fees for medical services or supplies which are; (a) Usually charged by the provider for the service or supply given; and (b) The average charged for the service or supply in the locality in which the service or supply is received; or (2) With respect to treatment or medical services, treatment which is reasonable in relationship to the service or supply given and the severity of the condition. Usual and Customary charges are calculated using the national database in Ingenix, Inc. or similar provider. Ingenix and similar providers update the data every 6 months.

Usual and Customary Charges means a reasonable charge which is: 1) usual and customary when compared with the charges made for similar services and supplies; and 2) made to persons having similar medical conditions in the locality where service is rendered. No payment will be made under this Plan for any expenses incurred which in the judgment of the Claims Administrator are in excess of Usual and Customary Charges.

Usual and Customary Charges as used in this Part means:

Usual and Customary Charges means the average amount charged by most providers for treatment, service or supplies in the geographic area where the treatment, service or supply is provided.

Usual and Customary Charges means those uniform charges that are listed in a provider’s established charge schedule which are in effect and applied consistently to most patients.

Usual and Customary Charges means a charge that: (1) is made for a Covered Accident Medical Service; (2) does not exceed the level of charges for similar treatment, services or supplies in the locality where the expense is incurred ; (3) for a Hospital room and board charge, other than for a Medically Necessary stay in an intensive care unit, does not exceed the Hospital’s most common charge for semi-private room and board); and (4) does not include charges that would not have been made if no insurance existed.

Usual and Customary Charges means the rates for Covered Services set forth in the charge master for the applicable Covered Entity at the time the Covered Services are rendered.