There are three basic ways insurance carriers determine how much they will pay for services covered by your health plan:

• First, insurance companies try to negotiate a predetermined, discounted price for each service your doctor provides.

• For services that can’t be discounted, insurance carriers research the average price (called the “Usual and Customary” or “U&C” price) that doctors in your area change for services.

• Many carriers are beginning to use the same rates the government uses to reimburse doctors who treat Medicare patients. The Medicare rate is the same for all doctors and is very low.

What this means for YOU:

Many people are switching to consumer driven insurance plans, which allow you swap a higher deductible for lower premiums. If you have such a plan, you’ll want to be sure you’re getting the best price for your care, since you’re paying for more of it yourself.

Know the Usual and Customary rate of the services you are seeking. Shop around for the best value. Some new websites are publishing this information, and can tell you if there are other reputable doctors charging less.  You can also visit the "Be a better healthcare consumer" section of this website.

The total combined rate you and your insurance carrier pay for health services should not exceed the Usual and Customary rate.