Ever read your health insurance policy? Did you make it past page 2 before you fell asleep or had to untie the knots in your brain? These aren't written for you, the consumer. They're written by lawyers, for lawyers. That means they use a lot of terms and language that have specific meanings. UCR is one of them. In this context, UCR stands for "Usual, Customary, and Reasonable". It means that your health insurance company will only pay what is...here it comes...usual, customary, and reasonable. It's there to protect them, not you, from being charged exorbitant prices for services that are usually much less expensive.
These days, it's not all that uncommon for a doctor to refuse to accept health insurance from their patients. That's because they want to charge whatever they want and not have to worry about a fee schedule or terms like UCR.
Be smart. Ask questions, especially with health insurance. If you have a good agent they will spend the time with you to make sure you understand your coverage.
UCR is short for "Usual, Customary, and Reasonable," meaning your health insurance company will only pay what they consider to be a usual, customary, and reasonable charge for any covered expenses you incur. If your doctor is in your insurance company's network, then they have agreed to accept this UCR as payment in full. However, it's not uncommon for a doctor to refuse to accept health insurance, or to participate in any HMO or PPO network. In such a case, if you doctor charges more than the amount your insurance company considers to be UCR, you are responsible for the rest of the bill. Worse yet, any amounts you pay above UCR will not count towards your deductible or your out pof pocket spending limit. If you ever find yourself in such a situation, I suggest working with a medical bill negotiation service. Most of these services cost nothing if they do not save you any money, and only charge a small percentage of any amount they are able to help reduce your bills (typically 30% of the savings).
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These days, it's not all that uncommon for a doctor to refuse to accept health insurance from their patients. That's because they want to charge whatever they want and not have to worry about a fee schedule or terms like UCR.
Be smart. Ask questions, especially with health insurance. If you have a good agent they will spend the time with you to make sure you understand your coverage.