A reasonable charge, with certain exceptions, is one that does not exceed the Provider's usual charge and does not exceed the customary charge. A usual charge is the most frequent charge made by an individual Provider for a given service to non-industrially injured patients. A customary charge is defined as a charge which shall have an upper limit no higher than the 90th percentile of usual charges made by Idaho Providers for a given service. The Commission's compilation of charges is updated at least once a year. It is not intended to be a mandatory fee schedule for services provided to industrially injured patients.
Medical reports are records which have been generated because a patient has been treated.
This is not an exclusive list. Medical services include medical, surgical, dental or other attendance or treatment, nurse and hospital service, medicines, apparatus, appliances, prostheses, and related services, facilities, equipment and supplies. As a form of medicine, pharmaceutical drugs are considered a medical service for purposes of the Commission regulations. After receiving a Motion for Approval of Disputed Charges, Commission staff reviews all documentation that was timely submitted. The Commission will issue an Administrative Order that approves or disapproves, in whole or in part, the disputed charges.