What is reasonable and customary? All insurers have a standard they use to determine whether a medical or dental charge is reasonable. At the Trust we call ours a reasonable and customary (R&C) fee limit. We maintain a list of the maximum dollar amount considered to be a reasonable charge for each medical or dental procedure. What happens when a provider charges more than our R&C fee? Your policy covers only that portion of a charge which does not exceed our R&C fee limit. If you receive an Explanation of Benefits (EOB) form from us indicating that the fee charged exceeds the R&C fee, it means that your provider charged more than what most providers are charging for that same service. In these instances, you’re responsible for paying the amount in excess of our R&C fee. How you can avoid excessive fees? When you receive services from Network providers, you can be assured that they have agreed to accept our payment as payment in full, less any applicable deductible and coinsurance payments. Check our Find a doctor feature to confirm whether the provider you are seeing is a Network provider before you receive care. How does the Trust determine what’s reasonable? We pay over two million claims each year. From these claims, we collect and analyze charges for procedures from providers throughout Wisconsin. After our analysis, we calculate a value for each procedure. These values are then adjusted by certain factors that take into account geographic, marketplace, and other legitimate price differences among providers. We update this data every six months so that our schedule of R&C fees remains current. Why not just pay whatever the provider charges? Our experience has shown us that charges for the same service can vary significantly from provider to provider. We establish R&C fee limits to protect our policyholders and subscribers. Excessive charges impose an unfair burden on all Trust subscribers and ultimately increase health and dental care costs and premium payments. If You're New If You're Retiring Know Your Plan Who's Covered Discount Networks Your Privacy

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