What is Usual, Customary & Reasonable (UCR)?

Q: What is Usual, Customary & Reasonable (UCR)?

UCR means the charge or fee determined by the Company to be the general rate charged by others who render or furnish such treatments, services or supplies to persons whose injuries or illnesses are comparable in nature and severity. The Company will consider such factors as; complexity; degree of skill needed, type of specialist required, and the range of services or supplies provided by the facility. For example, if a doctor charges $3,000 for a surgical procedure and the usual fee for the procedure is $2000 then the plan will reimburse you based on the charge of $2000 and applicable co-insurance will apply.

Question

Lauren Murray · Accepted Answer

UCR means the charge or fee determined by the Company to be the general rate charged by others who render or furnish such treatments, services or supplies to persons whose injuries or illnesses are comparable in nature and severity.
The Company will consider such factors as; complexity; degree of skill needed, type of specialist required, and the range of services or supplies provided by the facility. For example, if a doctor charges $3,000 for a surgical procedure and the usual fee for the procedure is $2000 then the plan will reimburse you based on the charge of $2000 and applicable co-insurance will apply.