What are Usual Customary and Reasonable Charges?

Usual, Customary, and Reasonable (UCR) charges are the amount paid for medical services in a geographic area based on what providers typically charge for similar services. Insurance companies use UCR rates to determine allowed amounts for out-of-network care, with "usual" referring to the provider's standard fee, "customary" representing the range of fees charged by similar providers in the area, and "reasonable" indicating the fee is justified given the circumstances.

Why usual customary and reasonable charges matter

• Determines out-of-network payments: Sets limits on what insurers will reimburse
• Affects patient responsibility: Creates potential balance billing for amounts exceeding UCR
• Varies by location: Reflects regional differences in healthcare costs

How Solace can help

A Solace advocate can help you understand UCR determinations for your claims, research typical costs in your area, and negotiate with providers who charge above UCR rates. Advocates can also assist with appeals when insurance payments based on UCR seem unreasonably low.