Question

When a provider does not have an agreement with the insurer for payment, they will be reimbursed a usual, customary, and reasonable fee. What is the term used to describe this fee?

1) Usual fee
2) Customary fee
3) Reasonable fee
4) All of the above

Answer 1

The term used to describe the fee that a provider is reimbursed when they do not have an agreement with the insurer for payment is usual, customary, and reasonable fee.

Step-by-step explanation:

The term used to describe the fee that a provider is reimbursed when they do not have an agreement with the insurer for payment is usual, customary, and reasonable fee. This fee is determined based on what is typically charged for the same service or treatment in that geographic area. It takes into account the usual fee charged by providers, the customary fee accepted by insurance companies, and what is considered reasonable based on the specific circumstances.