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Addendum B

Amounts Generally Billed (AGB) Calculation

Phelps Health provides financial assistance to patients who qualify and meet the eligibility guidelines set forth in the Financial Assistance Policy. No individual determined eligible for financial assistance will be charged more for emergency and medically necessary treatment than amounts generally billed (AGB) to individuals with insurance covering such care. The AGB is a percentage of Phelps Health's full, undiscounted charges for such care.

Phelps Health will use the Look-Back Method to calculate the AGB percentage, which is calculated as follows:

AGB % = Sum of Claims Allowed Amount $ / Sum of Gross Charges $ for Those Claims

  • The AGB is calculated annually at the end of each fiscal year for the past 12-month period. It will be calculated by reviewing all past claims allowed by both private and health insurers (including Medicare Advantage/Managed Care) and Medicare (traditional) for both inpatient and outpatient services having discharge dates from January 1 through December 31 of each year. This calculation will be used for the next fiscal year. It also can include coinsurance, copayments and deductibles.
  • Allowed Amount = Total hospital charges less contractual adjustments
  • Excluded Payers: Self-Pay, Medicaid and Medicaid Managed Care Plans

Effective April 1, 2019: AGB % Amount is 28.7%