Content Overview 
- Adverse Determination
- Annual Limits
- Case Manager
- Certificate of Creditable Coverage
- Coordination Of Benefits
- Co-Insurance
- Co-Pay
- Covered Charges
- Department Of Insurance
- Deductible
- Eligibility
- Experimental Treatment
- Explanation Of Benefits
- Extensions
- Fee-For-Service (Indemnity)
- Formulary
- Lifetime Limits
- HMO
- Medical Necessity (Medically Necessary)
- Out Of Network
- Out-of-Pocket Maximum (also known as "Stop Loss" or "Cap")
- Palliative Care
- POS
- PPO
- Renewability
- Pre-Existing Health Condition
- Stop Clause (also known as "Stop Loss Clause")
- Underwriting (What It Is And How It Works)
- U.S. Department Of Labor
- Usual, Customary and Reasonable "(UCR")
- Utilization Management
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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