In Malta, reasonable fees in health insurance refer to charges for medical services that are within the standard range for similar treatments in the local healthcare market.
Each insurance company sets its own reasonable charges (sometimes also referred to as “customary”, “fair” or “fair and reasonably” fees or charges) for each medical procedure or procedure category, which can vary greatly from one medical practitioner to another based on open market principals.
This process is applied in many different countries worldwide, in the absence of government-regulated maximum medical fees.
If a medical provider’s fees exceed the insurer’s defined reasonable charges, the policyholder may need to cover the difference out of their own pocket.
On the other hand, if the fees fall within the maximum fees established by your insurer’s list of Reasonable Charges, and your health insurance plan offers a “Full Refund of Reasonable Charges”, then these fees would typically be covered in full.
Before confirming an expensive medical procedure in Malta, it is important to always obtain a confirmation of maximum coverage from your health insurance provider. You may also compare fees charged by different medical practitioners for the same procedure.