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HIAAHIAA- How does HIAA determine "fair and reasonable" or...

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muncher | Student, Undergraduate | eNotes Newbie

Posted August 8, 2008 at 2:05 PM via web

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HIAA- How does HIAA determine "fair and reasonable" or "customary" charges for mental health practitioners? 

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urthona | (Level 1) Assistant Educator

Posted August 9, 2008 at 6:23 AM (Answer #2)

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According to the Division of Insurance of the Illinois Department of Financial and Professional Regulation, a “usual and customary” health care fee (and similar categories of fees, such as "fair and reasonable") is one that is “consistent with the average rate or charge for identical or similar services in a certain geographical area.” See its discussion of the H.I.A.A. methodology:

http://www.idfpr.com/DOI/HealthInsurance/Usual_Customary_Fees.asp

This somewhat dated New York Times article provides a more critical examination of the H.I.A.A. methodology:

http://query.nytimes.com/gst/fullpage.html?res=9C00E1DB133CF931A35757C0A9669C8B63&sec=health&spon=&partner=permalink&exprod=permalink

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