Insurance terms

Reasonable and customary fees refer to the standard charges accepted by healthcare providers in a specific geographic area for certain medical services or treatments. These fees are determined based on what healthcare professionals in the region typically charge for similar services, considering factors like the type of service, location, and prevailing market rates. Insurance companies often use these fees as a benchmark to establish the maximum amount they will cover for specific medical procedures or treatments. When a provider's fees exceed the reasonable and customary amount, the patient may be responsible for paying the difference out-of-pocket unless covered by specific insurance arrangements or agreements.