the lower of: a) the provider’s usual charge for furnishing the treatment, procedure, service or supply; or b) the charge determined by WellAway to be the general rate charged by others who render or furnish such treatments, procedures, services or supplies to persons: (1) whose Injury or Illness is comparable in nature and severity. The Usual, Reasonable and Customary Charge for a treatment, procedure, service or supply that is unusual, or not often provided in the area, or that is provided by only a small number of providers in the area, will be determined by WellAway. WellAway will consider such factors as: (1) complexity; (2) degree of skill needed; (3) type of specialist required; (4) range of services or supplies provided by a facility. When PPO providers are not available within a 50-mile radius of the insured person’s local residence, the Usual, Reasonable and Customary Charge may be the negotiated provider fee for such services.
This material is for informational purposes only and is subject to change. Please refer to your Policy Terms and Conditions for a complete description of the benefits, conditions, limitations and exclusions of coverage. Products and services may not be available in all jurisdictions and are expressly excluded where prohibited by applicable law.