Insurance Glossary

Insurance Term - Usual, Customary and Reasonable (UCR) Fees

An amount customarily charged for, or covered for similar services and supplies which are medically necessary, recommended by a doctor or required for treatment. Conventional indemnity plans operate based on usual, customary, and reasonable (UCR) charges. UCR charges mean that the charge is the provider’s usual fee for a service that does not exceed the customary fee in that geographic area and is reasonable based on the circumstances. Instead of UCR charges, PPO plans often operate based on a negotiated (fixed) schedule of fees that recognize charges for covered services up to a negotiated fixed monetary amount. In short, UCR charges is a term used to refer to the commonly charged or prevailing fees for health services within a geographic area. A fee is generally considered to be reasonable if it falls within the parameters of the average or commonly charged fee for the particular service within that specific community.

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