Are Usual and Customary Charges Reasonable?

Are Usual and Customary Charges Reasonable?

An editorial about the use of usual and customary charges for out-of-network benefit determinations.

Looking for the usual customary reasonable relationship.

Physician customary charges and Medicare payment experience: Study findings

Customary charges have had significant impacts in determining reasonable prices under the historic Medicare physician payment system. This article contains new, comprehensive information on customary charges as well as data aggregated at the physician level. These baseline data have some important policy implications, such as the study findings, that indicate that the Medicare fee schedule is l...

The Resource-Based Relative-Value Scale Reforms for Physician Payment

Although the “usual, customary and reasonable” concept may have been reasonable and workable as a basis for [physicians] billing individual patients, it has been a failure as a basis for reimbursement from insurance funds. Because it contains none of the limits or standards that are applied to other services covered by insurance, the charges for medical services have escalated, with little or n...

Prescription charges: are they worth it?

While Wales, Northern Ireland, and Scotland have abandoned charges for prescriptions, in April the English saw prescription charges rise once again, to £8.05 (€10; $13.5) per prescribed item. Labour peer David Lipsey has suggested that the charges are, “a dog’s dinner lacking any basis in fairness or logic and stuffed with anomalies and inconsistencies.” But apart from unfairness, illogicality,...