Carle Health is committed to providing accessible and affordable healthcare services to the community. A key component of this commitment is understanding how patient billing and financial assistance programs work, especially the Carle Financial Assistance Program (CFAP). This program ensures that eligible patients can access necessary medical care, and a crucial aspect of it is the Amounts Generally Billed (AGB).
The Amounts Generally Billed (AGB) for participants in the Carle Financial Assistance Program are calculated based on a methodology that considers Medicare fee-for-service data along with information from private health insurers over a preceding 12-month period. This calculation is crucial for determining fair and consistent billing amounts for those receiving financial assistance.
How AGB is Determined:
The AGB is determined through a specific calculation that takes into account several financial factors. It’s derived by summing all payments received by Carle, adding the total value of bad debt and charity care adjustments, and then dividing this sum by the total charges incurred during a defined timeframe. This timeframe is set from October 1st through September 30th of the prior calendar year. This method ensures a comprehensive and representative calculation of AGB, reflecting both payments received and adjustments made for charitable care.
For any questions regarding patient charges and billing, Carle Patient Financial Services is available to provide assistance. You can reach them at (888) 71-CARLE, or (888) 712-2753.
Self-Pay Patients and the Carle Financial Assistance Program:
For patients who are self-pay, Carle Health has implemented a process to streamline access to the Carle Financial Assistance Program. Starting Monday, April 15th, patients are automatically screened for CFAP eligibility during their appointment scheduling. If a self-pay patient is identified as potentially ineligible for CFAP, they will be required to pay a portion of the estimated charges before scheduling their appointment. This policy applies specifically within the Champaign-Urbana service area for appointments in Audiology, Ear, Nose and Throat (ENT), Eye, General Surgery, Oral and Maxillofacial Surgery, and Plastic Surgery departments.
However, it’s important to note that there are standard exceptions to this pre-payment requirement, ensuring that vulnerable patients are not hindered from receiving care. These exceptions include:
- Patients undergoing active cancer treatment (excluding subsequent or new treatments).
- Patients in their second or third trimester of pregnancy.
- Newborns requiring 48-hour post-delivery follow-up care.
- Patients in any trimester of a high-risk pregnancy or receiving Maternal Fetal Medicine services.
- Patients within a 90-day global follow-up period after surgery.
- Patients meeting Red List criteria at a Convenient Care site, indicating urgent needs.
- Patients receiving services in the NICU Developmental Follow Up Clinic.
- Patients receiving Psychiatry or Behavioral Health Services.
- Patients with a referral for an Emergency Department (ED) follow-up with their Primary Care Physician (PCP) within 1-2 days.
- Patients with Neurosurgical-Spine Trauma requiring a follow-up appointment after hospitalization.
This list of exceptions is designed to protect patients with ongoing or urgent medical needs, ensuring they can schedule appointments without the immediate burden of prepayment.
If you have any inquiries regarding the self-pay payment scheduling process, please contact Carle Patient Accounts at the same contact number: (888) 71-CARLE (888-712-2753). Carle Health is dedicated to ensuring financial concerns do not prevent patients from accessing the care they need within our community care program.
