Health · Chapter 15 · Basic Plans
Usual, Customary & Reasonable (UCR)
Definition
Non-scheduled plans pay based on what 70–80% of practitioners in the geographic region charge for the service. UCR is the maximum eligible basis — charges above it are the insured's problem.
In plain English
The insurer pays 'the going rate' for your area — if your surgeon charges more, that extra is on you.
Easy to confuse with
These are what this term gets tested against — if you can't tell them apart cold, drill the contrast.
Related terms