Department of Labor and Regulation

Title - Division of Insurance email the Division of Insurance

Usual and Customary and Reasonable Charges (UCR)

Pre-certification does not guarantee reimbursement. Virtually all major medical policies today have a clause that allows the insurance company to limit payment to the UCR charges for that area and that particular procedure based on the average amount charged by care providers in your area.

If the hospital's or doctor's charge exceeds the company's limit for that procedure, the company will pay their maximum allowance leaving you responsible for the remainder. If this occurs, you may wish to contact your doctor to verify the procedure and charge and inquire if the procedure required additional time or effort to justify the cost. You may also contact your company and doctor prior to any surgery to determine the charge and payment schedule.

Division of Insurance
124 S. Euclid Ave., 2nd Floor
Pierre, SD 57501
Tel. 605.773.3563
Fax. 605.773.5369