Discount Fee Policy
This practice is committed to serving all patients. You will not be denied services based on inability to pay. This policy is posted in our waiting area.
Discounts are offered to uninsured patients based upon family/household size and annual income. A sliding fee schedule is used to calculate the basic discount and is updated each year using the Federal Poverty Guidelines. Once approved, the discount will be honored for six months, after which the patient must reapply.
Our Office Manager can help you set up a payment plan or supply you with the Discounted Fee Application.
Discount Application Process
A completed application including required documentation of the home address and household income must be on file and approved by the office manager before a discount will be granted. If the applicant appears eligible for Medicaid, a written denial of coverage will be required.
Adolescent patients seeking confidential care are exempt from the application process and services are provided at the nominal rate.
We have established this policy to ensure that a non-discriminatory, uniform and reasonable charge is consistently and evenly applied without regard to the treating clinician. Patients whose household income and family size place them at or below poverty will need to pay a nominal fee. Patients between 101%-250% of poverty are expected to pay a percentage of the full fee based on your poverty level. A discounted fee schedule applies only to direct patient charges.
If you think you may qualify for the discounted fee, you will need to complete a written application to determine financial eligibility. Your privacy will be protected.
To determine eligibility, we ask you to bring in a copy of three recent pay stubs. Eligibility will also be based on current participation in federal/state public assistance programs including: Social Security Disability income (SSDi), Temporary Assistance for Needy Families (TANF), or free or reduced school lunch programs.
Household size is determined by mother, father, and dependent children under 18. Other adults in the household, even though related, are not included.
Front desk staff will ask if any pertinent information has changed since the patient’s last visit. For example, if the patients’ annual income has changed, then a re-evaluation of your discount status would be necessary.