What Does ‘Reasonable & Customary’ Mean?

Thursday, 11 November 2021

Reasonable & Customary

If you have ever gone to out of network doctor, you may already be familiar with the term ‘reasonable and customary’, and we’ll explain why.

Reasonable and customary is a term that the health insurance companies use to make sure that you are paying a reasonable and fair amount for your covered medical services. The health insurance companies render a large amount of information, take the data, and average out the numbers to make sure that what the provider is charging you is a fair amount based off your area and the services being rendered.

So, if you ever receive an EOB, or Explanation of Benefits, with the term ‘reasonable and customary’ on it, you can sleep well at night knowing that you are paying a fair, contracted amount for your medical services.

Now, here’s the catch: you are only going to receive reasonable and customary charges if you go to an in-network provider that is contracted with your health insurance carrier.

If you choose to see an out of network provider, that means that provider is not contracted with your health insurance company and can essentially charge you whatever they want! You will not receive reasonable and customary charges for your services and will most likely pay more out of pocket than if you were to go to an in-network provider.

Have questions? Give Clevenger Insurance a call today at 574-267-2181.

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