Many insurance plans state that you will be covered "up to 50%, 80% or 100%." In spite of this statement, we have found in actuality that many plans may cover less than that, depending on their established usual and customary fees. Insurance companies use the term usual and customary when setting fee limitations on services. The benefits paid by your plan are largely determined by how much your employer or union paid for the plan. Please be aware that some insurance companies will pay a claim percentage based on their usual and customary fees, not our actual charges. It is for this reason that we require 1⁄3 of the total estimated charges to be paid at the time of the surgery.