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How To Maximize Use Of A Fee-For-Service (Indemnity) Health Insurance Policy

Avoid Paying Money In Excess Of Usual, Customary And Reasonable

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A fee for service insurer will not pay medical expense above Usual, Customary and Reasonable (UCR) for your geographic area.

The company that gathers data that is used in UCR does not make the numbers available to the general public. Even if it did, each company then applies its own formula to the base data.

If you are concerned that your out-of-network doctor or other health care provider may charge more than UCR, contact customer service at your insurance company prior to incurring the expense. Ask how much UCR is for the appointment, test or treatment. Or, to put the question another way: How much does the company pay for the service in your area?

If you and the insurance company disagree, see Arguments To Use Against An Insurer's Denial Of A Health Claim the section titled: A Claim Denied On The Basis That The Charges Are Not Usual, Customary and Reasonable)

Also consider speaking with your doctor about lowering his or her fee.

  • The American Medical Association says doctors have an obligation to compassionately consider the patient's ability to pay.
  • Studies show that people who negotiate fees with doctors are successful at least 50% of the time.
Ask the doctor to accept an in-network fee as if he or she were part of a managed care plan, or accept what Medicare pays. To find out what Medicare pays for the procedure, see offsite link, look for physician's fee schedule

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