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HELPFUL TERMS
R.

Professional fees of Non- Affiliated physicians for services rendered to Maxicare Members which do not exceed the standardized professional fees/terms of the Maxicare Affiliated Physicians/Specialists where the services were rendered. Reasonable charges are usually determined by the lowest limit of the actual charge, the prevailing charge in the locality, the physicians customary charge, or the carrier’s usual payment for comparable services.

  • A condition/disorder/disease entity is said to be related if it is associated with the particular diagnosis in question either as a direct symptom/sign, a risk factor, an underlying cause, a part of a syndrome, or a complication.
  • The type of hospital room and board pre – assigned by Maxicare to the Member based on the plan enrolled in.

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