Insurance term
UCR (Usual, Customary and Reasonable)
Definition
UCR is the amount a payer considers a usual, customary and reasonable fee for a procedure in a given area, used to set its allowed amount.
Why it matters for the front desk
UCR matters most for out of network patients. The plan pays its percentage of the UCR amount, not of the office's fee, and the patient may owe the difference when the office charges more. In network offices use the payer's contracted fee schedule instead. Explaining UCR clearly helps out of network patients understand why the plan paid less than the percentage they expected.
Related terms
- Coinsurance Coinsurance is the percentage of a covered procedure's cost that the patient pays after the deductible, with the plan paying the rest.
- Downgrade (Alternate Benefit) A downgrade, or alternate benefit, is a plan rule that pays for a less expensive treatment than the one performed.
- Deductible A deductible is the amount a patient must pay out of pocket each benefit year before the plan starts paying for covered services.