Usual, Reasonable and Customary; most everyone knows the meaning of these three words when each is used by itself. However, string them together, pair it with the word “charges” and it raises some eyebrows. Usual, Reasonable and Customary coverage (URC) refers to a fee typically charged for a specific procedure for a specific geographic area.
This term is used when referring to insurance coverage; however the concept of this term is also used by many citizens in the United States on a daily basis, perhaps without them even noticing. Someone who lives in one area of the United States does not always pay the same price for the same goods and services as someone who lives across the country, or even across the state.
For example, Sally might normally pay an average price of $2.50 for a cup of coffee throughout New York City. However, one day she stops in at a new coffee shop that is charging $5.00 for a cup of coffee. This $5.00 is not the Usual, Reasonable and Customary charge to what other shops in New York City are charging for the same product.
Of course this is not an example of Usual, Reasonable and Customary charges within your insurance plan; however it does make the concept more understandable. Whether Sally pays the additional price for a cup of coffee is up to her. However, when regarding insurance only the Usual, Reasonable and Customary charge is coverage when URC is the benefit. Medical providers charging an amount that is not URC for a certain procedure in a certain area may not be fully covered when a plan has Usual, Reasonable and Customary coverage. URC is used to describe the maximum amount an insurance company will pay for eligible medical expenses. There is plenty of insurance terminology. Now you can be a little bit more familiar with at least one of the terms.