Common use of Reasonable Charge Clause in Contracts

Reasonable Charge. The charge for a Covered Benefit which is determined by the HMO to be the prevailing charge level made for the service or supply in the geographic area where it is furnished. HMO may take into account factors such as the complexity, degree of skill needed, type or specialty of the Provider, range of services provided by a facility, and the prevailing charge in other areas in determining the Reasonable Charge for a service or supply that is unusual or is not often provided in the area or is provided by only a small number of providers in the area. • Referral. Specific directions or instructions from a Member’s PCP, in conformance with HMO’s policies and procedures, that direct a Member to a Participating Provider for Medically Necessary care. • Respite Care. Care furnished during a period of time when the Member's family or usual caretaker cannot, or will not, attend to the Member's needs. • Service Area. The geographic area established by HMO and approved by the appropriate regulatory authority. • Skilled Care. Medical care that requires the skills of technical or professional personnel.

Reasonable Charge. The charge for a Covered Benefit which is determined by the HMO to be the prevailing charge level made for the service or supply in the geographic area where it is furnished. HMO may take into account factors such as the complexity, degree of skill needed, type or specialty of the Provider, range of services provided by a facility, and the prevailing charge in other areas in determining the Reasonable Charge for a service or supply that is unusual or is not often provided in the area or is provided by only a small number of providers in the area. • Referral. Specific directions or instructions from a Member’s PCP, in conformance with HMO’s policies and procedures, that direct a Member to a Participating Provider for Medically Necessary care. • Respite Care. Care furnished during a period of time when the Member's family or usual caretaker cannot, or will not, attend to the Member's needs. • Service Area. The geographic area area, established by HMO and approved by the appropriate regulatory authority. • Skilled Care. Medical care that requires the skills of technical or professional personnel.

Reasonable Charge. The charge for a Covered Benefit which is determined by the HMO to be the prevailing charge level made for the service or supply in the geographic area where it is furnished. HMO may take into account factors such as the complexity, degree of skill needed, type or specialty of the Provider, range of services provided by a facility, and the prevailing charge in other areas in determining the Reasonable Charge for a service or supply that is unusual or is not often provided in the area or is provided by only a small number of providers in the area. • Referral. Specific directions or instructions from a Member’s PCP, in conformance with HMO’s policies and procedures, that direct a Member to a Participating Provider for Medically Necessary care. • Respite Care. Care furnished during a period of time when the Member's family or usual caretaker cannot, or will not, attend to the Member's needs. • Service Area. The geographic area area, established by HMO and approved by the appropriate regulatory authorityOffice of the Insurance Commissioner. • Skilled Care. Medical care that requires the skills of technical or professional personnel.