[Health Insurance] 11, Usual Customary and Reasonable Charges

This podcast is made by Ran Chen, who holds an EA license, Insurance and Securities licenses (Series 6, 63, 65), and the CFP® designation. He is passionate about opening access to high-quality exam preparation resources and helping learners prepare more effectively for professional certification exams. In this episode you will learn: - That UCR is the maximum amount an insurer recognizes for a service in a specific geographic area, based on what local providers usually charge. - How balance billing occurs when an out-of-network provider charges more than the UCR amount and bills the patient for the difference. - That all insurer payment calculations (like coinsurance) are based on the UCR amount, not the provider's higher actual charge. - How to calculate the insured's total out-of-pocket cost by adding the deductible, coinsurance, and the full balance-billed amount together. - The critical difference between UCR for out-of-network care and contractually negotiated rates for in-network providers, who cannot balance bill. For more free exam prep tools, practice questions, and AI-powered explanations, visit https://open-exam-prep.com/ or YouTube Channel: https://www.youtube.com/@Open-exam-prep