At CAMC the AGB is determined through the “Look-back method” which is calculated as follows:

  • Reviewing all past claims allowed by Medicare fee-for-service together with all private health insurers paying claims to the hospital in a prior 12-month period. This amount can include co-insurance; copayments and deductibles. Current AGB is 47.57%.
  • The AGB for emergency or medically necessary care provided to a financial assistance eligible individual is determined by multiplying gross charges for that care by one or more percentages of gross charges (called "AGB percentages").
    • The percentages are calculated at least annually by dividing the sum of certain claims allowed by health insurers during the prior 12-month period by the sum of the associated gross charges for those claims.   
    • Multiple AGB percentages may be calculated for separate categories of care (for example, in-patient verses out-patient care; or care provided by different departments) or for separate items or services.
  • The percentages are applied by the 120th day after the end of the 12- month period the hospital facility used in calculating the AGB percentage(s).

 

Updated 04/14/2023