Reasonable and Customary

Also referred to as UCR (Usual, Customary, and Reasonable).

♦ It is an amount that your insurance company believes is a reasonable charge for the medical services received. The amount is supposed to be based on what providers in the area usually charge for the same or similar service.

This can vary considerably from one insurance company to another.

♦ This can affect you the most when using an out-of-network provider.

Your insurance company will be making a determination as to how much to pay using Reasonable and Customary.

It is most likely that the out-of-network provider will not be willing to accept their determination.

♦ Reasonable and Customary does not apply to in-network providers because they are under contract and have agreed to accept specific fees for certain services.