Navigating healthcare costs can be confusing, and at Carle, we are committed to providing clarity and support. This article explains how Amounts Generally Billed (AGB) are determined for participants in the Carle Community Care Program and outlines important updates regarding payment processes for self-pay patients.
How Amounts Generally Billed (AGB) are Calculated
For patients enrolled in the Carle Community Care Program, the Amounts Generally Billed (AGB) are calculated based on a standard methodology. This approach ensures fairness and consistency in billing. The AGB is determined by considering Medicare fee-for-service rates alongside payments from private health insurers over a 12-month period.
The specific calculation involves:
- Summing all payments received from Medicare and private health insurers.
- Adding the total value of bad debt and charity care adjustments made during the same period.
- Dividing this combined sum by the total charges incurred within the timeframe.
This calculation is performed using data from the prior calendar year, specifically from October 1st through September 30th. This consistent timeframe allows for accurate and up-to-date AGB determinations.
If you have any questions about patient charges or the AGB calculation, please do not hesitate to contact Carle Patient Financial Services at (888) 71-CARLE or (888) 712-2753.
Important Update for Self-Pay Patients
Effective Monday, April 15th, Carle is implementing a new process to better assist self-pay patients. During the appointment scheduling process, all patients will be automatically screened for eligibility for the Carle Financial Assistance Program.
If the screening identifies you as a self-pay patient who is not eligible for the Carle Financial Assistance Program, you will be asked to make a partial pre-payment towards your estimated charges before your appointment can be scheduled. This policy applies unless your medical situation falls under a standard exception.
This pre-payment process is currently applicable to appointment scheduling within the Champaign-Urbana service area and specifically affects the following departments:
- Audiology
- Ear, Nose and Throat (ENT)
- Eye
- General Surgery
- Oral and Maxillofacial Surgery
- Plastic Surgery
Standard Exceptions to the Pre-Payment Policy
Recognizing that certain medical situations require immediate access to care, Carle has established a standard exceptions list for the pre-payment policy. Patients meeting the following criteria will be exempt from the pre-payment requirement:
- Patients currently undergoing active cancer treatment (excluding subsequent or new treatments).
- Patients in their second or third trimester of pregnancy.
- Newborns requiring a 48-hour post-delivery follow-up appointment.
- Patients in any trimester of a high-risk pregnancy or receiving care from Maternal Fetal Medicine.
- Patients within a 90-day global follow-up period after surgery.
- Patients meeting Red List criteria at a Convenient Care location.
- Patients receiving services at the NICU Developmental Follow Up Clinic.
- Patients receiving Psychiatry or Behavioral Health Services.
- Patients with a referral for an Emergency Department (ED) follow-up appointment with their Primary Care Physician (PCP) within 1-2 days.
- Patients with Neurosurgical-Spine Trauma who are allowed one follow-up appointment post-hospitalization.
We understand that these policy updates may raise questions. If you have any concerns or require further clarification regarding the self-pay payment scheduling process, please do not hesitate to contact Carle Patient Accounts at (888) 71-CARLE (888) 712-2753. Carle is dedicated to ensuring you receive the care you need while providing transparent and supportive financial processes.
