What does Usual Reasonable and Customary (URC) mean?
Usual Reasonable and Customary is a term that insurance companies use to describe a limitation on their responsibility to pay for eligible medical expenses. Basically, URC refers to the fee typically charged by a provider for a specific procedure in a specific geographic area. So if a particular procedure typically costs $5,000 in the New York City area, and most providers customarily charge about $5,000 for that procedure, the insurance company will not pay your provider in New York City $10,000 for the same exact procedure. Instead, they will limit their payment amount to “Usual Reasonable and Customary” – in this example, $5,000.
