By Doug Aldeen
“If I ain’t getting a 95% discount, I am getting screwed”
New Jersey based Capital Health may have the lowest AGB percentage in the US at 6.41%. This means that for every dollar this facility “charges , it collects 6.41 cents of all allowed amounts between Medicare Fee for Service and commercial accounts (both self funded and fully insured).
This is the “real number” in my humble view inside most facility’s. Let that sink in. If I ain’t getting a 95% discount, I am getting screwed. More importantly, WHO is paying for a 20% discount?
Sunday Morning Bathroom Read Plan Sponsor Takeaways:
1. Claims data= Rx/medical/plan participant financial information ( Prior two year tax returns);
2. The Capital Health System is now your de facto stop loss carrier. Why pay a stop loss premium if, as an example, 40% of your group qualifies either in whole or in part for financial assistance?
Want to know if you are getting screwed by your insurance company? Find out what the hospital’s AGB is and compare to your EOB. If you can’t find the AGB on the hospital’s website, ask for it in writing:
Subject – Request for Current AGB Percentage Request for Current AGB Percentage
I am writing to request the current Amounts Generally Billed (AGB) percentage used by NAME OF HOSPITAL for purposes of its Financial Assistance Policy and compliance with IRC ยง501(r).
Would you please provide the present AGB rate, the effective date, and whether it is calculated using the look-back method or the prospective Medicare/Medicaid method?
If available, I would also appreciate any documentation that shows how the percentage was derived.
Thank you for your assistance.
