Most travel insurance plans reimburse based on Usual, Reasonable and Customary charges (UCR) for all covered expenses.
Let’s Understand Usual Customary and Reasonable (UCR) Based Reimbursement
Usual Customary & Reasonable reimbursement refers to an established maximum amount that an insurance company will reimburse for a particular medical service or procedure, covered under a travel health insurance policy. UCR charges are generally based on prices that are typically billed by majority of providers, for each medical procedure or service, in a particular geographical area. The UCR can vary from one geographical area to another. The insurance companies use independent third party data to determine the UCR for different services in different geographical areas.
For instance, if in a certain geographical area 95% of physicians charge $100 for doctor’s consultation, then a particular insurance company may establish the UCR for that area as $100 for doctor’s visits and $100 is the maximum that the insurance company may reimburse for a doctor’s visit in that particular area. UCR may vary from company to company.
Where Can I See the Established UCR For Different Areas?
There is no one certified source that provides this information publicly. There are private independent companies that determine these charges based on extensive research. Insurance companies either collect this data or procure this data from these companies to establish their UCR.
You may call your insurance company to inquire or request for this information. You may also communicate with your service provider (doctor or hospital) and request for their charges for a particular medical service.