What does usual, customary, and reasonable mean?
Usual, customary, and reasonable (UCR) charges for covered services are determined by using the usual level of charges made by the majority of dentists in the same geographic area for the same service. If your dentists fee is lower than the UCR charge, the plan will pay benefits based on the actual fee. If the fee is higher, the plan will pay benefits based only on the UCR charge, and you are responsible for any amount above the UCR limit.
Usual, customary, and reasonable (UCR) charges for covered services are determined by using the usual level of charges made by the majority of dentists in the same geographic area for the same service. If your dentist’s fee is lower than the UCR charge, the plan will pay benefits based on the actual fee. If the fee is higher, the plan will pay benefits based only on the UCR charge, and you are responsible for any amount above the UCR limit.
Those words refer to the charges and costs that are typical or standard for your region. Let’s say that the usual, customary and reasonable fee, based on an accurate study of doctors’ charges, for an anesthesiologist is $500. But he charges you $600, so your insurance will pay its percentage of the $500. You’ll pay anything above that percentage of the $500, plus your deductible.
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?
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