Usual, Customary, And Reasonable Charges

What Does Usual, Customary, And Reasonable Charges Mean?

Usual, customary, and reasonable (UCR) charges refer to medical expenses that are necessary, reasonably priced, and provided by a doctor or other covered healthcare provider. Health insurance companies typically cover only UCR charges, as they consider charges above this amount to be unnecessary or excessive.

Insuranceopedia Explains Usual, Customary, And Reasonable Charges

Usual, customary, and reasonable (UCR) charges are essentially a method for insurance companies to avoid paying excessive or unnecessary amounts for claims. For example, if five doctors in a town offer a necessary surgery for the same price, but one doctor charges twice as much, the UCR charge would be the price set by the five doctors. If the patient chooses to use the more expensive doctor, they would be responsible for covering the difference between the UCR charge and the higher fee.

That difference comes out of the patient’s own pocket, on top of any premiums, deductibles, co-pays, and coinsurance they already owe. Because UCR limits vary by insurer and by region, it is worth checking how a plan calculates them when comparing health insurance plans.