Usual, Customary, and Reasonable (UCR)
A historical method of calculating out-of-network 'allowed amount' based on regional fee data.
UCR is a historical methodology for calculating out-of-network allowed amounts. The plan looks at usual fees in the geographic area and applies a percentile (e.g., 80th percentile of all charges in that ZIP) as the allowed amount. UCR has been criticized for using insurer-controlled data; the FAIR Health database (a non-profit consumer-facing alternative) provides independent benchmarks. The No Surprises Act displaces UCR for protected OON services.
Frequently asked questions
What is usual, customary, and reasonable (ucr)?
UCR is a historical methodology for calculating out-of-network allowed amounts. The plan looks at usual fees in the geographic area and applies a percentile (e.g., 80th percentile of all charges in that ZIP) as the allowed amount. UCR has been criticized for using insurer-controlled data; the FAIR Health database (a non-profit consumer-facing alternative) provides independent benchmarks. The No Surprises Act displaces UCR for protected OON services.
Related terms
- Out-of-network (OON)A provider who doesn't have a contract with your plan. Cost-sharing is higher and you may face balan
- Allowed amountThe maximum amount your plan considers payable for a covered service. Calculated cost-sharing is bas
- No Surprises Act (NSA)Federal law (effective 2022) banning balance billing for most emergency and certain non-emergency ou
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