Key insurance terms that start with "U"

The process your insurance company uses to review whether a health care service is medically necessary and appropriate. Your insurance company may require prior authorization and may deny claims if they determine a service isn't necessary. You can appeal a utilization review decision.

Urgent care refers to medical treatment for conditions that need prompt attention but are not life-threatening emergencies. Urgent care centers offer walk-in access without an appointment and typically have extended hours, including evenings and weekends. They bridge the gap between your primary care physician and the emergency room.

Conditions appropriate for urgent care include:

• Infections (ear, sinus, UTI, strep throat)
• Minor cuts or lacerations that may need stitches
• Sprains and minor fractures
• Mild asthma or allergic reactions (non-severe)
• Flu-like symptoms
• Minor burns

Urgent care centers are covered by most health plans, usually with a copay that falls between your primary care copay and your ER copay. Always verify the center is in-network before visiting — urgent care costs vary significantly between in-network and out-of-network facilities.

Urgent care is not the right choice for chest pain, stroke symptoms, severe difficulty breathing, major trauma, or any condition where immediate life-saving treatment may be needed. Those require an emergency room.

A measurement of what a health care service typically costs in your geographic area. Your insurance company uses UCR to determine the allowed amount for out-of-network providers. If a doctor charges more than the UCR amount, you may pay the difference through balance billing.