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Usual, Customary or Reasonable (UCR)

An industry term for the typical rates charged for services in a specific region. For example, if a surgeon in Virginia were to charge twice as much for a surgery as the average cost of that procedure in the area, those charges would not be considered usual, customary or reasonable.

Gatekeeper

A colloquial term for a primary care physician who is responsible for coordinating patient care and referring the patient to specialists. Many insurance programs, particularly…