Reasonable and customary limits are the amount your health plan will pay based on the range of usual fees for comparable medical services in a geographic area. If your provider charges more than the reasonable and customary limit, you will be responsible for paying the difference.
Ranges can vary based on whether you have a medical condition that warrants non-standard therapy.
Like other health benefit providers, Pacific Blue Cross reviews and uses reasonable and customary limits on a continual basis to determine maximum eligible amounts for health care services and supplies covered by your plan. Smart shopping for health care products and services helps members by reducing out of pocket expenses and helps employers reduce benefit plan costs.
Starting January 1, 2017, the length of treatment (in minutes) for physiotherapy and massage must be indicated on your receipt when submitting. It’s important to ask your practitioner to specify the length of treatment on your receipt to receive the correct reimbursement for your claim.
Receipts and online claims submitted without the length of treatment will be reimbursed based on a 20 minute physiotherapy session and a 30 minute massage therapy session.
View reasonable and customary limits for paramedical coverage (pdf).