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OseInsurance plans that pay a physician's full charge if it does not exceed his normal charge or does not exceed the amount normally charged for the service is called______________?

1) Usual, customary and reasonable
2) Comprehensive
3) Dual choice
4) Dual choice

User Gerharddc
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1 Answer

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Final answer:

The insurance plans that pay a physician's full charge if it does not exceed their normal charge or the usual fee for the area are called Usual, Customary, and Reasonable (UCR) plans. These are different from fee-for-service or HMO payment models and include payments made after deductibles and copayments.

Step-by-step explanation:

The type of insurance plans that pay a physician's full charge if it does not exceed their normal charge or does not exceed the amount normally charged for the service is called Usual, Customary, and Reasonable (UCR). These plans take into account the typical fees charged by healthcare providers within a particular region. Under a UCR plan, if a physician's charge for a service is within the range of what is usual, customary, and deemed reasonable in that specific area, the insurer will pay the full charge, after any required deductible or copayment is made by the patient. This payment model contrasts with other types such as fee-for-service or payments to Health Maintenance Organizations (HMOs), where the former pays according to specific services rendered, and the latter involves a fixed amount per enrollee, irrespective of services provided.

User Samuel Cole
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