Reasonable and Customary Charges
Reasonable and customary charges mean charges for medical services or supplies, which are standard charges for a specific healthcare provider. These charges should be consistent with prevailing rates for similar or identical healthcare services in that geographical area. The comparison is usually done based on the diagnosis of illness and the line of treatment adopted by the medical practitioner.
All health insurance policies in India have reasonable and customary charges clause in the policy document. In case the hospital charges more than reasonable and customary charges for treatment, the insurer will pay only to the extent of reasonable and customary charges, leading to out-of-pocket expenses for the policyholder.
The reasonable and customary charges clause in health insurance protects the insurance company from unreasonably inflated hospital bills. If you don’t want to fall into this trap and pay a portion of your claim out-of-pocket, try to avail cashless claim facility or review the charges at your hospital before going for a planned hospitalisation.
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A
- Accident
- Acute Care
- Acute Condition
- Age Limit
- Agent
- Ambulance Cover
- Annual Health Checkup
- Annual Renewal Date / Renewal Date
- Any One Illness
- AYUSH Treatment
B
C
- Cancer Insurance
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- Claim
- Claim Assessment
- Claim Rejection / Claim Repudiation
- Claim Settlement
- Claim Settlement Ratio
- Comorbidity
- Congenital Anomaly
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D
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- Deductible
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- Domiciliary Hospitalisation
- Durable Medical Equipment
E
F
G
H
I
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- Injury
- Inpatient Care / Inpatient Hospitalisation
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- Insurer
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L
M
N
O
P
- Personal Accident Cover
- Planned Hospitalisation
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- Pre-Authorisation (of Cashless Claims)
- Pre-Existing Disease (PED) / Pre-Existing Condition
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R
- Reasonable and Customary Charges
- Reimbursement
- Renewal
- Renewal Premium
- Restoration Benefit / Automatic Restoration
- Rider / Add-on Cover
- Room Rent Limit
S
- Shared Accommodation
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- Surgery or Surgical Procedure
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