The act of reviewing and evaluating prospective insured persons for risk assessment and appropriate premium.
Health care provided in situations of medical duress that have not reached the level of emergency. Claim costs for urgent care services are typically much less than for services delivered in emergency rooms.
USUAL AND CUSTOMARY (U&C) CHARGE:
A term used to refer to the commonly charged or prevailing fees for health services within a geographic area. A fee is generally considered to be reasonable if it falls within the parameters of the average or commonly charged fee for the particular service within that specific community. “Usual and Customary (R&C)” essentially means the same thing as “Reasonable and Customary (R&C) Charge.”
A mechanism by which the appropriateness, necessity, and quality of health care services are monitored by both insurers and employers.