Sentence examples for customary charge from inspiring English sources

Peter V. Lee, a health policy expert at the Pacific Business Group on Health, an employers' group, said, "The whole mythology that there is a usual and customary charge has been part of what has made insurance hard to understand for patients as well as doctors".

To determine how much of the medical bill they will pay, insurers calculate the so-called reasonable and customary charge for a given procedure or medical service and then pay a percentage of that amount, which is frequently much less than the doctor's or hospital's actual bill.

That's because insurers often pay based on usual and customary charges for a specific treatment in your geographical area.

They claim that health insurers and Ingenix disproportionately eliminate high charges, thus skewing the numbers for customary charges downward.

In addition, the rule says, states should compare Medicaid payment rates with the amounts paid by Medicare or commercial insurers, with providers' costs or with their customary charges.

P.P.O.'s generally cover some percentage of out-of-network fees, usually 70 or 80 percent of so-called usual and customary charges.

Whatever that investigation unearths, it is already clear that the system for calculating "reasonable and customary" charges ought to be reformed by making it truly independent and objective.

In licensing its database to insurers, it stresses that the data is "for informational purposes only" and does not imply anything about "reasonable and customary" charges.

Medical negotiation companies rely on trained investigators and negotiators to review medical bills, identify charges that might be incorrect or excessive (based on so-called usual and customary charges), and negotiate with doctors or hospitals to lower the charge.

Mr. Moy said the society's only other significant continuing suit against an insurer was also against United, challenging its definitions of "usual and customary" charges for medical care.

Individuals who use doctors outside the insurer's networks are generally required to pay a certain percentage, typically 20percentt, of "reasonable and customary" charges — a calculation that is supposed to reflect the prevailing market rate in a given geographic area for a doctor visit or other services.