Navigating healthcare costs can be challenging, and understanding financial assistance options is crucial. Carle Health is committed to providing accessible care, and the Carle Financial Assistance Program (CFAP) is a key resource for patients concerned about medical expenses. This program aims to help eligible patients manage their healthcare costs effectively.
One important aspect related to CFAP is the Amounts Generally Billed (AGB). Carle calculates AGB based on a combination of factors, primarily using Medicare fee-for-service data and information from private health insurers over a 12-month period. Specifically, AGB is determined by adding up all payments received and any adjustments made for bad debt and charity care, then dividing this sum by the total charges within the timeframe of October 1st through September 30th of the previous calendar year. This calculation ensures a fair and consistent approach to billing for patients enrolled in the financial assistance program.
For patients who are considered self-pay, it’s important to be aware of Carle’s pre-payment policy. As of April 15th, Carle Health automatically screens patients for CFAP eligibility during appointment scheduling. If a patient is identified as self-pay and not eligible for CFAP, they may be asked to pay a portion of their estimated charges before their appointment can be scheduled. This policy currently applies to appointments within the Champaign-Urbana service area, specifically for departments including Audiology, Ear, Nose and Throat (ENT), Eye, General Surgery, Oral and Maxillofacial Surgery, and Plastic Surgery.
However, there are standard exceptions to this pre-payment requirement. Patients are exempt under various circumstances, including those 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, patients in any trimester of a high-risk pregnancy, and those within a 90-day global follow-up period after surgery. Additional exceptions apply to patients meeting Red List criteria at Convenient Care sites, those receiving services in the NICU Developmental Follow Up Clinic, patients receiving Psych or Behavioral Health Services, individuals with referrals for ED follow-up with their primary care physician within 1-2 days, and Neurosurgical-Spine Trauma patients requiring a single follow-up after hospitalization.
If you have any questions about the Amounts Generally Billed, the Carle Financial Assistance Program, or the self-pay payment scheduling process, Carle Patient Financial Services and Carle Patient Accounts are available to assist you. You can reach them at (888) 71-CARLE, or (888) 712-2753. They can provide detailed information and personalized guidance to help you understand your options and access the financial support you may need.
