Reasonable And Customary

Definition


Reasonable And Customary: Within Canadian insurance, the amount an insurer deems acceptable to pay for a particular good or service in a given geographic area. It represents the typical amount most providers charge for the same treatment, procedure, or item, excluding any premium or extra charges beyond what is common and medically necessary in the insured person’s province or territory at the time of service. Insurers compare submitted fees against local billing patterns and fee guides (e.g., provincial dental or health professionals’ associations). Any excess above the reasonable and customary amount remains the customer’s responsibility unless otherwise specified in the policy.

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