Usual, Reasonable and Customary Charges (URC)

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The average cost of a specific medical procedure in your geographic area. This is the maximum amount some insurance companies will pay for certain covered expenses. Also referred to as allowed expenses. They reflect the provider’s retail cost of service. For example, the actual fee for open-heart surgery may be more than your plan’s reasonable and customary charges. In that case, you would be responsible for the difference, and the amount you pay would be applied to your maximum out-of-pocket.

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