What is Usual, Customary, and Reasonable Charges (UCR)?
TOP In the insurance world, a popular phrase considers whether or not a particular fee charged by a physician, dentist, or other health professional is “usual, customary, and reasonable,” or “UCR.” As a consumer, it’s important to understand these terms, since they can affect insurance reimbursement and additional out-of-pocket charges that you might have to pay. The following tips provide useful information about “UCR’s.” Usual: A charge is considered “usual,” if it is a physician´s usual charge for a procedure. Customary: A charge is considered “customary,” if it is within a range of fees that most physicians in the area charge for a given procedure (often measured at a specific percentile of all charges submitted for a given procedure in that community). Reasonable: A charge is considered “reasonable,” if it’s usual and customary or if it’s justified because of special conditions.
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 are usual, customary and reasonable (UCR) charges?
