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For decades, they had been paying physicians according to what were called "usual, customary, and reasonable fees".
Vacuuming up information from doctors and other health care providers, Ingenix calculates the "usual, customary and reasonable rate" for medical services in different geographic areas.
A nonprofit group, now known as Fair Health, was set up to become, in effect, a new arbiter of "usual, customary and reasonable" prices.
The out-of-network cap may not apply if charges exceed "Usual, Customary and Reasonable -in otheReasonable -ind chunk otherur favorite specialist's bill.
In a criminal probe that could have national implications, Barber says the FBI has interviewed him about a midwestern hospital that tripled its "usual, customary and routine" prices so it could claim to be granting big discounts and still gouge self-insured plans.
Using your usual (customary) language, do you have difficulty communicating, for example understanding or being understood?
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One thousand three hundred fifty-six veterans will be randomized to one of four treatment arms: CBT plus aerobic exercise plus usual and customary care, aerobic exercise plus usual and customary care, CBT plus usual and customary care, or usual and customary care alone.
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.
Insurers use the data to determine usual and customary rates for care received outside their networks.
That's because insurers often pay based on usual and customary charges for a specific treatment in your geographical area.
But the Senate Ethics Manual requires that any payment Senate authors receive "be in accordance with usual and customary contractual terms".
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com