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Glossary of Health Insurance Terms To Know

Usual, Customary and Reasonable "(UCR")

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"Usual, Customary and Reasonable" ("UCR") is a term used in the context of determining how much an insurer will pay for a particular health care service. The idea behind the term is to provide a standard by which an insurer decides how much to pay for the service provided in a particular geographic area.  The fee is based on what most other local hospitals, physicians or laboratories charge for a similar procedure or service.

Each insurer has its own list of what is Usual, Customary and Reasonable. Companies generally start with statistics compiled by a national organization and then apply their own formulae.

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