Travel Insurance Explained: Usual Customary or Reasonable Charges from VisitorsCoverage on Vimeo.
Usual, Customary and Reasonable charges, or UCR, are typically what most travel insurance plans base their reimbursements on for covered expenses under a policy. This will affect how much you are reimbursed for certain treatments or services after filing a claim with your travel insurance plan’s provider.
What is UCR in Insurance?
Usual, Customary and 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.
Who Determines Usual, Customary and Reasonable Rates?
Usual and customary 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. Charges that are usual, customary and reasonable 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.
What is Considered Usual and Customary?
A fee is typically considered usual, customary and reasonable if it falls in line with the amount that is usually charged for a doctor visit, treatment, or service. Additionally, the price range of the fee should fall within that of what other doctors or hospitals in the area are charging for the same service, treatment, or visit.
What is the Maximum Amount That an Insurer Will Reimburse for a Covered Service or Procedure?
The maximum amount that a travel insurance provider will reimburse for a covered service or procedure depends upon the plan you have. For example, comprehensive plans will cover a percentage of the total eligible expenses but a limited plan may only pay a fixed amount for each service, visit, or treatment. It’s advised to read your travel insurance policy’s description of benefits for more information on how much you can expect to be reimbursed for a particular service.
Where Can I Find UCR Charges for Different Areas?
Unfortunately, there is no one certified source that provides information publicly on UCR charges by area. Typically, these charges are determined based on research performed by independent companies which is then shared with insurance companies to establish their UCR charges.
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 ask about their charges for a particular medical service.
To know more about how much Usual, Customary and Reasonable reimbursement an insurance company will pay, visit our travel insurance plan page to compare policies, or contact our Customer Success Team for assistance.
