Usual and Customary. (U&C) shall mean covered expenses which are identified by the Plan Administrator, taking into consideration the fee(s) which the Provider most frequently charges the majority of patients for the service or supply, the cost to the Provider for providing the services, the prevailing range of fees charged in the same “area” by Providers of similar training and experience for the service or supply, and the Medicare reimbursement rates. The term(s) “same geographic locale” and/or “area” shall be defined as a metropolitan area, county, or such greater area as is necessary to obtain a representative cross-section of Providers, persons or organizations rendering such treatment, services, or supplies for which a specific charge is made. To be Usual and Customary, fee(s) must be in compliance with generally accepted billing practices for unbundling or multiple procedures.
Usual and Customary means the comparable level of charges for similar treatment, services and supplies in the geographic area where treatment, services or supplies are provided or performed.
Usual and Customary charges means the following:
Examples of Usual and Customary in a sentence
The health care benefits provided herein shall be substantially similar to the benefits provided under Nebraska Blue Cross?Blue Shield "Usual and Customary" policy as said policy exists on the effective date of this Agreement, a summary of which is attached as Appendix "C".
Medical?Surgical: Usual and Customary Charges Paid for Surgery, In?Hospital Visits, X?Rays and Pathology.
More Definitions of Usual and Customary
Usual and Customary means the fee that the provider usually charges nonmedicaid customers for the same service or item. This is the maximum amount that the provider may bill the agency.
Usual and Customary or “U&C” means the amount a participating provider would charge to a cash paying customer for same strength, quantity, and dosage form of a covered drug, as of the date the prescription is filled.
Usual and Customary means the fee(s) for medical services or supplies which is (are):
Usual and Customary means the charge associated with a medical or surgical supply, service, procedure or Prescription Drug which represents the normal charge level for that procedure in the geographic area of service.
Usual and Customary means the fee regularly charged and received for a given service by a health care provider when furnishing customary treatment for a similar condition or Injury as represented by the 70th percentile of the Ingenix MDR database. We shall provide to a Covered Person, upon his written request, an estimate of the amount We will pay for a particular procedure or service. However, We will not be bound by such good faith estimate.
Usual and Customary. (U&C) shall mean Covered Services which are identified by the Plan Administrator, taking into consideration the charge(s) which the provider most frequently bills the majority of patients for the service or supply, the cost to the provider for providing the service or supply, the prevailing range of charges billed in the same “area” by providers of similar training and
Usual and Customary. (U&C) means eighty percent (80%) of a specific provider’s billed charges.