Introduction
Most insurers have a clause referred to as Usual, Customary and Reasonable (UCR) charges, Efficient Market Place (EMP) price or Reasonable Charges. Although referred to differently, insurers use this to ensure that the amount they are paying their associated medical providers are reasonable and fair based on geographical location. Following on from our recent proposed re-rate for UCR, we have since received feedback from our readers and updated accordingly.
As previously indicated: we began by renaming the item from “UCR Limits” to “Network or market price limits/UCR” then categorised and evaluated how insurers apply UCR/EMP/reasonable changes. We appreciate that UCR limitations in whatever form are rarely applied. We think that’s reflected in the share of the total score that this affects. For context, typical product scores range between 94 and 107 points whereas the score for this item varies from 0.05 points to 0.7 points.
Item re-weighting
Your feedback
We value getting your feedback on how these wordings are being applied to claims you may be aware of. Please email us with details of any recent claims to help us update our understanding. Doreen Dutt, Research Manager, Quality Product Research Limited, researche[email protected]