UCR (Usual, Customary and Reasonable)
Usual, customary and reasonable charges (UCR) are the maximum amounts that will be covered by the plan for eligible services. The plan pays an established percentage of the dentist's fee or pays the plan sponsor's "customary" or "reasonable" fee limit, whichever is less. Although these limits are called "customary: they may or may not reflect the fees that area dentists charge. Exceeding the plan's customary fee, however, does not mean your dentist has over-charged for the procedure. Why' There are no regulations as to how insurance companies determine reimbursement levels, resulting in wide fluctuation. In addition, insurance companies are not required to disclose how they determine usual, customary and reasonable-charges.