Your English writing platform
Discover LudwigSimilar(60)
Insurers use the data to determine usual and customary rates for care received outside their networks.
One of its subsidiaries, Ingenix, determines the "customary" rates for medical care for health insurance companies -- a likely conflict-of-interest right there.
It will also be getting "75percentt of the Contractor's usual and customary rates for all reasonable non-attorney time expended in connection with the Litigation," as well as reimbursements for "reasonable expenses" related to the case.
In earlier days there was often not even individual bargaining, because customary rates of pay prevailed that might be unchanged for many years at a time.
Now assume that your employer has opted for H.I.A.A. 80 as its "reasonable and customary" rate, and that the surveys peg that fee for the exam at $200.
For example, when GSHI payments are lower than the usual and customary rate, patient out-of-pocket expenses may create an obstacle to receiving a timely biopsy.
In the case of a $275 liver checkup, for example, the balance due was $175, almost three times the patient share under Fair Health's customary rate, and three and a half times what it was five years ago under Ingenix.
And the customary rate now is ten percent gross of what the band makes going to the agency.
A firm may account for this reasonable rate of return by using its customary discount rate for an investment of similar risk.
That is the disturbing possibility raised by an investigation of the industry's arcane procedures for calculating "reasonable and customary" rates.
United Health owns Ingenix, the company used by the industry to calculate reasonable and customary rates.
Write better and faster with AI suggestions while staying true to your unique style.
Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com