What Does Usual, Customary and Reasonable Mean (UCR)?
Because you can go anywhere you’d like for services, chances are the insurance company won’t have a contract with the doctor or provider of services you decide to go to. Therefore, the insurance company has no control over the amount of money your doctor or provider is billing for their services. The insurance company has to control costs somehow. What they (the insurance companies) do is establish usual, customary and reasonable charges for any kind of services you might receive. Usual, Customary and Reasonable (UCR) is the maximum amount an insurance company will consider eligible for reimbursement under group health insurance plans. It is based on surveys of prevailing fees in a geographic area. Typically, you are responsible for any charges for a covered service that exceeds the usual, customary and reasonable (UCR) amount indicated for that specific service. Example: You receive bill for a covered service in the amount of $125 and the UCR charge for that covered service is $100, t
Related Questions
- Plans say they pay for usual, customary, and reasonable (UCR) or reasonable and customary (R&C) charges. What does UCR and R&C mean and how is it determined?
- Plans say they pay for Usual, Customary & Reasonable (UCR) or Reasonable & Customary (R&C) charges. What does UCR or R&C mean and how is it determined?
- What Does Usual, Customary and Reasonable Mean (UCR)?
