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Schedule of Benefit for Medical Fees

Reasonable and Customary charges  
Transparency of Charges with Patients  
Unbundling  
Multiple Procedures  
Misrepresentation  

Reasonable and Customary charges

In your membership agreement we explain that we will not pay charges higher than those customarily made. This rarely happens but it is obviously important that we should only pay fees that are at the level normally charged. Through experience we have established what is generally charged for all the procedures that we cover and we query any charges which are above that normal range. Our decision reflects both domestic and international practice where appropriate and cost of living indices.

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