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.
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The information and advice on this website was deemed accurate when it was originally published. GNI cannot accept any responsibility or liability for any actions taken on the basis of the information provided, unless that information is subsequently confirmed in writing. For the latest up-to-date information please call us or check brochures and other published materials for latest revision/date.