If you don’t have health insurance or are worried about paying for care, our Sliding Fee Program can help.
Our Sliding Fee Program helps people who have limited or no health insurance. Patients will be charged for services based on their income and the number of people in their household. To apply for the Sliding Fee Program, you must meet with a financial counselor and provide proof of income and proper identification.
How to Apply
Eligibility for the Sliding Fee Program depends on your income and the number of people in your family/household. You will need to bring a document to prove your income, such as:
- Federal tax return (form 1040)
- Two most recent paycheck stubs
- Self-employment- a copy of Schedule C & any other schedules
- Social Security/SSI award letter or statement
- Pensions/retirement
- Unemployment compensation letter or checks
- Alimony
- W-2 or other government grant checks
- Rental Income
- Workers’ Compensation
- Interest, dividends, rents, royalties, income from estates, trusts, educational assistance
Patients who attest to no sources of household income must complete ‘Sliding Fee Scale Discount No Income Attestation’ form. The applicant will be placed at Slide Fee Scale Level A and will be asked to pay the nominal fee associated with the service. The Financial Counselor will discuss various program options such as health insurance, foodshare and other community programs for possible eligibility.