Usual, Customary, and Reasonable (UCR)

Also called: UCR

Usual, customary, and reasonable is a benchmark plans use to decide how much to pay for a service, especially out-of-network, based on typical charges in the area. If a provider bills above the UCR amount, the plan may pay only up to that figure and leave you responsible for the rest. Disputes over how a UCR rate was calculated can be a basis for appeal.

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Disclaimer: This definition is provided for general educational purposes only and is not legal, medical, or insurance advice. Insurance rules, deadlines, and terminology vary by plan, state, and over time. Always check your own plan documents and confirm current details before acting.