What Does Usual, Customary, and Reasonable Charges (UCR) Mean?
Usual, customary, and reasonable charges are charges that pay for medical expenses that are necessary, reasonably priced, and provided by a doctor or other covered health care provider. Usual, customary, and reasonable charges are also known as UCR charges. Health insurance companies often will only cover UCR charges, as they feel charges above that are unnecessary.
Insuranceopedia Explains Usual, Customary, and Reasonable Charges (UCR)
Usual, customary, and reasonable charges are essentially a way for insurance companies to prevent themselves from having to pay an exorbitant or an unnecessary amount of money for claims. For example, if there are five doctors in a town who will do a certain necessary surgery for one price, and there is another doctor who will only do it for twice as much as the others, the UCR charge would be the price offered by the five doctors. If the patient wanted to use the more expensive doctor, then he or she may have to pay the difference between the UCR charge and the expensive doctor's fee.