Health Insurance UCRs May Have Downward Bias

Health insurers typically establish “usual, customary and reasonable (UCR) rates” for reimbursing direct health care providers. The amount paid may be at full or partial UCR. The patient is responsible for paying the balance. The UCR rates are supposed to reflect typical charges for a particular service within a geographic market.

Charles Bell, Consumers Union Programs Director, in testimony before the Senate claimed that UCR rates for out-of-network providers have not be calculated in a fair and impartial way. The Attorney General for New York found that within that state UCRs understated physician expenses by 10 to 28 percent. Moreover, there is no easy way for consumers to check on the accuracy of the UCRs.

For text and video on the complete Senate Hears go to PART I: Deceptive Health Insurance Industry Practices – Are Consumers Getting What They Paid For?