Field notes · The mechanics
Reasonable and customary, in a market that has no tariff.
There is no tariff for foreign payers in Egypt. None.
Customary defaults to your own payment history unless you anchor it.
The phrase your policy relies on
Nearly every travel and health policy promises to pay reasonable and customary charges. In a market with a published tariff, that phrase has teeth: there is a number to point to. On Egypt's Red Sea coast there is no tariff for foreign payers. There is no published fee schedule, no negotiated network rate that binds anyone, and no regulator who prices an appendicectomy for a tourist. So when your desk writes "we settle at reasonable and customary rates" to an Egyptian hospital, the honest question is: customary according to whom?
In practice the phrase collapses into the one reference both sides can see, which is your own payment history. What you paid last season becomes this season's customary. The standard that was supposed to protect you is quietly redefined by your own settlements, one unread invoice at a time.
Three reference points that actually exist
A defensible reasonable-and-customary position in Egypt can be built, but it has to be built from references that exist on the ground:
| Reference | What it is | What it tells you |
|---|---|---|
| The domestic price | What the same hospital charges an Egyptian patient, or a local insurer, for the same bed and the same procedure | The cost base plus a normal margin. The gap between this and your invoice is the touristic fee, and it is negotiable. |
| The documented record | The complete clinical file behind the invoice | Whether the billed care happened, was needed, and lasted as long as billed. No rate is reasonable for treatment the record does not support. |
| The regional corridor | What comparable private hospitals in the region invoice for comparable cases | A sanity corridor. ADAC has said publicly that bills reaching its desks ran at 20 to 30 times German rates; a corridor argument is how you answer that. |
The layer most desks miss
Reasonable and customary is usually argued as a pricing question. The stronger half of the argument is clinical. A perfectly priced line for a procedure that was not indicated is not reasonable at any rate. That is why the review has to read the record beside the invoice: the necessity question comes first, the rate question second. A desk that argues rates while conceding necessity has given away the larger half of the bill before the conversation starts.
Illustrative exchange, the two halves in one conversation
Your daily ward rate is far above the customary range. We propose a corrected rate.
Our rates reflect our private standard and our imported equipment. The rate is our rate.
Then let us set the rate aside for a moment. The record documents four inpatient nights; the invoice bills seven. Whatever the right rate is, it applies to four nights. Shall we begin there?
Where there is no tariff, your discipline is the tariff.
What I do with this
I read the full clinical record beside the invoice and give you, in writing, the two findings a reasonable-and-customary position needs: what the documented care actually was, and what the same care costs when it is not priced to a foreign guarantee. That letter is the difference between asserting the phrase and being able to defend it, to the hospital, to your auditor, and if it ever comes to it, to a court.
Where no tariff exists, your review discipline is the tariff. Build the three reference points before the next big file.