Reasonable and customary limits are the normal range of fees for services and supplies in a given geographical area as identified by an insurance carrier. These limits are often applied to paramedical practitioners (chiropractor, physiotherapist, massage therapist, etc.) and medical and dental service providers who do not have to adhere to a provincial fee guide.
If a service provider charges more than the R&C limit, you will need to pay the difference out of pocket. By shopping around for service providers that are at or below the R&C limits, you minimize your out-of-pocket expenses for any amounts above R&C limits.
Wondering if your medical or dental service provider’s fees are within R&C limits?
You can check them on GroupNet for Plan Members.
Note also that services and supplies submitted through the plan must represent reasonable treatment – meaning that they must be accepted by the Canadian medical profession, proven to be effective, and be of a form, intensity, frequency and duration that is essential to diagnose or manage a disease or injury.
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