Help Desk FAQ

Health insurance


What are usual, customary, and reasonable (UCR) fees?

This term is used to identify fees paid by medical insurers for medical or dental treatment if you are insured under an indemnity plan.

UCR fees are determined by insurance providers based on the typical costs associated with various procedures in different geographical areas. Insurers typically use the services of third party companies in determining UCR fees.

Indemnity insurance plans, as compared to managed care plans, allow you to select your own providers and typically these plans promise to pay a certain percentage of your medical costs, such as 80%, while you must pay 20%. However, UCR fees mean that often, you must pay more (sometimes much more) than your 20%, because the insurer bases its 80% on UCR costs.

As an example, your doctor charges $150 for a test or procedure. Your insurance provider may have a UCR for the procedure of $110. You, the insured person, would be responsible for paying 20% of the UCR, plus the difference of $40.

Although UCR fee policies typically are spelled out in the fine print of the insurance policy, many consumers are surprised by the added cost when they receive a bill.





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