Where can I find a medical "usual and customary fees" list which is free and accurate for my state?

Question

My state is Arizona.

Also - is there a list of medical codes somewhere?

Answer 1

Hi Barb,

There are two different criteria used.  Usual & Customary which is determined by the insurance companies, and other answers are correct, the insurance company won't disclose that information.

Then there is Customary & Reasonable, which can be based upon Centers for Medicare Services.  Medicare rates should be available through www.cms.com. The problem with that is that it's going to be listed by medical procedure code, which you have to know on your own before you can get any information.

I have also experienced that Usual and Customary fee lists are changed through out the year.  So your hunt to find a list may be not so helpful if once you get the list, they change costs associated with the lists.

Good luck!

Kathy K

www.premiumwatchdog.com

Answer 2

You can't.  Insurance companies don't publish what they consider reasonable for competitive reasons.

Answer 3

You can't.

First of all, the data is regional (usually based by county or zip code) rather than statewide.  This is due to cost of living differences that can occur in different cities, even within the same state.

Second of all, each insurer uses their own methodology to arrive at the usual and customary rate.  (Most base their calculation off of a standard list...such as statistics complied by the Health Insurance Association of America (HIAA).)

This page from the Illinois Department of Insurance gives a pretty good description of how insurers arrive at usual and customary rates.  (Even if you aren't from Illinois, the general descriptions are still helpful:  http://www.idfpr.com/DOI/HealthInsurance...  )

P.S.  You didn't mention what state you're located in.  Someone might be able to point you towards some general info for your state, if you list it.  It might not be exactly the level of detail you were hoping to get, but at least it would be a good starting point.

Answer 4

For the codes... You can buy a CPT book to get a list of medical codes... or ask your doctor. or do a search on line using the name/description of the service or procedure. Free? not sure...  If you are wanting codes for a specific specialty, try looking on a website for that specialty type's board. They have coding initiatives, & FYIs, etc.

For the U&C: Try looking on the cms website. Each insurance uses their own U&C methodology, however, everyone follows CMSs lead. They set the bar. So, try www.cms.gov do a search for RBRVS & the code you want to find the info for... P.S. the rates change yearly...

Are you looking for the entire schedule? or just a few codes? I can find codes, if you can provide the service/procedure name.