Usual, Customary and Reasonable Fees
Definition
- The fees that a medical treatment generally costs and how much an insurer is willing to pay for that treatment. Usual, customary and reasonable fees (UCR) are split into three parts. "Usual fees" are what the medical professional normally charges for a given procedure, "customary fees" are what the insurer is willing to pay for a given procedure, and "reasonable fees" are fees the medical professional may charge when a procedure has complications or unusual circumstances.
Synonyms
common fees, standard, expected
Related Terms and Acronyms
- Case Management — Definition,
- A system where medical services and patient treatments are coordinated by a case manager.
- Gatekeeper — Definition,
- In relation to health maintenance organizations, a gatekeeper is a primary care physician that arranges medical care for policyholders.
- Health Maintenance Organization (HMO) — Acronym, Important,
- A healthcare plan where insured people receive reasonably priced health insurance through an organization with firm guidelines on the scope of care.
- Medical Loss Ratio — Definition,
- A method of comparing the medical costs paid to the premiums earned by an insurance company in a specific period of time.
- Point of Service Plan — Definition,
- A health insurance plan that combines the features of both health maintenance organizations and preferred provider organizations.
- Pre-existing Condition (PRE-X) — Acronym,
- A medical condition that's occurrence precedes the writing of an insurance policy.
- Preferred Provider Organization (PPO) — Acronym,
- A health care program that gives its members a level of freedom and independence when choosing health care options.
- Primary Care Physician — Definition,
- A doctor who administers or arranges the majority of an individual's health care needs.
- Unallocated Benefit — Definition,
- A requirement for health insurance policyholders to pay reasonable hospital expenses out of pocket to a certain limit.
