HANDLING CLAIMS - USUAL, REASONABLE & CUSTOMARY

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This page contains dozens of short articles that will help you quickly understand international insurance. For example, terminology, purchasing details and managing your insurance coverage are topics that are all covered within these articles. Choose an Article From the Topics Below

HOW INSURANCE COMPANIES DETERMINE “USUAL, REASONABLE & CUSTOMARY”

Most major health insurance companies use a national database from Igenix, a health information company, that tracks health service and care charges throughout the USA. Their database contains more than 900 million current fees in more than 270 geographic ZIP-code groupings. These groupings are broken down by three-digit, ZIP- code radius for each service. The “Usual, Reasonable and Customary” charges are based on data closest to the place of service. This method gives greater accuracy in calculating medical charges (taken from AMS Producer, 3/06).

Healthcare companies are well aware that charges for a Cat Scan in California, Florida or New York will be more than for a Cat Scan in Iowa. When they agree to pay “Usual, Reasonable and Customary” charges, they are basing those charges on what the real cost is where you received the medical care.