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The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.
- Browse Related Terms: Allowed Amount, Balance Billing, interest, Out-of-Pocket, UCR (Usual, Customary, and Reasonable), Usual and Customary Charges (UCC), Usual, Customary and Reasonable (UCR), Usual, Customary and Reasonable (UCR) Charges, Usual, Customary and Reasonable charge (UCR), Usual, Customary, Reasonable (UCR), Utilization Review
All > Healthcare > Health Insurance
Health care or services provided by hospitals or health care providers that don't get reimbursed. Often uncompensated care arises when people don't have insurance and cannot afford to pay the cost of care.
- Browse Related Terms: Capitation, claim, External Review, Federally Qualified Health Center (FQHC), Fee-for-Service, Health Care Workforce Incentive, Home Health Care, Internal review, Member Survey Results, Original Medicare, Penalty, Uncompensated Care, Value-Based Purchasing (VBP)
All > Healthcare > Health Insurance
If you do not currently have health insurance, you are uninsured.
- Browse Related Terms: agent, Authorized Representative, Broker, Brokers, Connector Organizations, Exchange, Marketplace, Small Business Health Options Program (SHOP), Uninsured
All > Healthcare > Health Insurance
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
- Browse Related Terms: Chronic Condition, Durable Medical Equipment (DME), Emergency Medical Condition, Hospice Services, Major Medical Plan, Public Health, Reconstructive Surgery, Special Health Care Need, Urgent Care
All > Healthcare > Health Insurance
The amount that your insurance company determines is the normal payment range for a specific medical procedure performed within a given geographic area. If the charges you submit to your health insurance company are higher than what is considered normal for the covered health care services, then your health insurance company may not allow the full amount charged to you.
- Browse Related Terms: Allowed Amount, Balance Billing, interest, Out-of-Pocket, UCR (Usual, Customary, and Reasonable), Usual and Customary Charges (UCC), Usual, Customary and Reasonable (UCR), Usual, Customary and Reasonable (UCR) Charges, Usual, Customary and Reasonable charge (UCR), Usual, Customary, Reasonable (UCR), Utilization Review
All > Healthcare > Health Insurance
The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.
- Browse Related Terms: Allowed Amount, Balance Billing, interest, Out-of-Pocket, UCR (Usual, Customary, and Reasonable), Usual and Customary Charges (UCC), Usual, Customary and Reasonable (UCR), Usual, Customary and Reasonable (UCR) Charges, Usual, Customary and Reasonable charge (UCR), Usual, Customary, Reasonable (UCR), Utilization Review
All > Healthcare > Health Insurance
The cost associated with a health care service that is consistent with the going rate for identical or similar services within a particular geographic area.
Reimbursement for out-of-network providers is often set at a percentage of the “usual, customary and reasonable” charge, which may differ from what the provider actually charges for a service.
When an insurer disallows a portion of a charge as being in excess of the Usual and Customary allowance, it means only that the charge is in excess of the standard the company used to determine Usual and Customary, or UCR. Providers are free to charge whatever fee for service they choose. Your insurance coverage is designed to provide benefits up to the plan’s Usual and Customary percentile and is priced accordingly.
Your policy should contain a definition of Reasonable and Customary (or UCR) and explain how claims will be paid. If you disagree with the amount paid or if you believe a claim was denied improperly, there is a step-by-step process by which consumers may appeal the decision.
- Browse Related Terms: Allowed Amount, Balance Billing, interest, Out-of-Pocket, UCR (Usual, Customary, and Reasonable), Usual and Customary Charges (UCC), Usual, Customary and Reasonable (UCR), Usual, Customary and Reasonable (UCR) Charges, Usual, Customary and Reasonable charge (UCR), Usual, Customary, Reasonable (UCR), Utilization Review
All > Healthcare > Health Insurance
The cost associated with a health care service that is consistent with the going rate for identical or similar services within a particular geographic area. Reimbursement for out-of-network providers is often set at a percentage of the usual, customary and reasonable charge, which may differ from what the provider actually charges for a service. Minn. Stat. 62A.61 requires disclosure of methods used by health carriers to determine usual and customary fees.
- Browse Related Terms: Allowed Amount, Balance Billing, interest, Out-of-Pocket, UCR (Usual, Customary, and Reasonable), Usual and Customary Charges (UCC), Usual, Customary and Reasonable (UCR), Usual, Customary and Reasonable (UCR) Charges, Usual, Customary and Reasonable charge (UCR), Usual, Customary, Reasonable (UCR), Utilization Review
All > Healthcare > Health Insurance
The amount paid for a medical service in a geographic area based on what providers in the area usually charge for the same or similar medical service. The UCR amount sometimes is used to determine the allowed amount.
- Browse Related Terms: Allowed Amount, Balance Billing, interest, Out-of-Pocket, UCR (Usual, Customary, and Reasonable), Usual and Customary Charges (UCC), Usual, Customary and Reasonable (UCR), Usual, Customary and Reasonable (UCR) Charges, Usual, Customary and Reasonable charge (UCR), Usual, Customary, Reasonable (UCR), Utilization Review
All > Healthcare > Health Insurance
Insurance companies and hospitals watch their costs and quality by having medical personnel review selected medical cases. They look at the types and frequency of medical services given and the charges associated with them.
- Browse Related Terms: Allowed Amount, Balance Billing, interest, Out-of-Pocket, UCR (Usual, Customary, and Reasonable), Usual and Customary Charges (UCC), Usual, Customary and Reasonable (UCR), Usual, Customary and Reasonable (UCR) Charges, Usual, Customary and Reasonable charge (UCR), Usual, Customary, Reasonable (UCR), Utilization Review