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Term Details - Usual, Customary and Reasonable Charges (UCR)

The prevailing, average amount that health care providers within a given geographic area (such as a state or county) tend to charge for a specific medical service. Insurance plans often set their payments/ reimbursement rates as a percentage of average UCR charges, rather than as a percentage of an individual providerís actual fee. Most insurance plans consider the UCR data they collect to be proprietary (confidential) information, so it may be difficult for members to determine whether their providerís fee is more or less than the planís UCR; however, it is possible to ask whether a provider will honor the insurance planís UCR rate.

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