Indemnity Plan:A health plan that pays a specific amount for any provider you see regardless of network status. This is basically fee-for-service.
PPO:Preferred Provider Organization. This policy allows you to see a provider you wish without the need for a referral. Some of these plans pay more for in-network providers versus out-of-network providers.
HMO:Health Maintenance Organization is an insurance that pays at a higher level if you see an in network provider and rarely allows out-of-network providers to receive authorization or reimbursement. This can vary plan to plan.
UCR:Usual Customary and Reasonable or “Allowed Amount”. By law, the medical insurance companies must pay providers a fee that is usual for a covered service. In theory, this is assumed to be the average fee charged for the service in your area paid to providers. However, each insurance company seems to have their own UCR fee schedule. As an out-of-network provider, insurance companies are not required to disclose how much their UCR or “Allowed Amount” is. If your insurer says they will pay a percentage of the fee for an oral device (maybe 80%) they will only pay 80% of their UCR, not the fee submitted. Please be aware that you are responsible for our full fee as we are not obligated to accept your insurance UCR since we are out-of-network.