How to check UCR rate for an out-of-network claim by state and region

An out-of-network provider is a healthcare provider or facility that does not have a contract with your insurance company. If you receive care from an out-of-network provider, you may be responsible for a greater share of the cost. The customary rate for an Out of network claim is the rate or amount that is typically charged by providers for a specific service or procedure in a specific region or state.

Out-of-network usual, customary, and reasonable (UCR) rate is the amount that healthcare providers typically charge for a specific service or procedure in a certain geographic area. It is used by insurance companies to determine how much they will reimburse for out-of-network claims.

Here are some websites that allow you to check the UCR rate for an out-of-network claim by state and region:

• Fair Health Consumer Website: Allows you to search for the UCR rate for a specific procedure or service in your area.
• Healthcare Bluebook: Provides UCR rate information as well as a “fair price” for procedures and services.
• Healthcare Cost Estimator by UnitedHealthcare: Allows you to search for the UCR rate for a specific procedure or service in your area.
• Medicare.gov: Provides UCR rate information for specific procedures and services.
• HealthSparq: Allows you to search for the UCR rate for a specific procedure or service in your area based on your insurance plan.
• Healthcare.com: Allows you to search for the UCR rate for a specific procedure or service in your area.

Please keep in mind that these websites are not exhaustive and may not have information for all providers and regions. Additionally, your state’s Medicaid website or private health insurance company’s website may also provide the UCR rate information for out-of-network claims in your area. It is important to note that these websites are informative and not authoritative and best way is to check with your insurance company.

It’s important to note that these websites may not provide the exact customary rate for a specific provider and it’s always good to check with your insurance company or the provider for the most accurate information.

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