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.
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.
Share this Term
Stay informed with Insuranceopedia!
The world of insurance can be complicated. Subscribe to the Insuranceopedia newsletter and stay in the know! Access expert content, industry term definitions and answers to your questions from knowledgeable insurance insiders. Arm yourself with what you need to know to keep your assets and your family safe.
Latest Articles
