Fundamentos de Accidente y SaludPregunta 479 de 716
The term 'usual, customary, and reasonable' (UCR) charge refers to:
a.The amount a plan treats as appropriate for a service based on the prevailing fees charged in that geographic area
b.The flat copayment due at a visit
c.The plan's annual deductible
d.The monthly premium the insured pays for the coverage, a fixed cost unrelated to how a plan decides a reasonable charge for a service
Explicación
A UCR charge is the amount an insurer considers reasonable for a given service, determined by the usual fee the provider charges, the customary fees of similar providers in the same area, and what is reasonable for the situation; the plan bases reimbursement on this figure, and the insured may owe amounts a provider bills above it. UCR is not the deductible, premium, or copay. UCR limits how much a plan will recognize for out-of-network or fee-for-service charges.
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Revisado por John Zihao Zhang — California-Licensed Life Insurance Agent (CA Dept. of Insurance License #4396095 — verificar)