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Our Sliding Fee Program offers reduced prices on office visits and all other services provided in the clinic to all individuals and families who qualify.
The Sliding Fee Program is based on family income and may reduce your bill 20% or more. You may qualify with or without insurance and you may qualify even though you have Medicare or Medicaid. If you have private insurance that will be billed first and then the sliding fee program will take effect. To see if you are eligible, refer to the table below. Find your family size and your family's annual to find out what amount you qualify for.
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SLIDING FEE SCHEDULE BASED ON INCOME GUIDELINES PUBLISHED January 23th, 2008 | ||||||||||||
|
FAMILY |
You Pay 0% |
You Pay 20% if your income is |
You Pay 40% |
You Pay 60% |
You Pay 80% |
You Pay 100% | ||||||
|
SIZE |
From |
To |
From |
To |
From |
To |
From |
To |
From |
To |
From |
To |
|
1 |
$ 0 |
$10,400 |
$10,401 |
$13,00 |
$13,001 |
$15,600 |
$15,601 |
$18,200 |
$18,201 |
$20,800 |
$20,801 |
and over |
|
2 |
$ 0 |
$14,000 |
$14,001 |
$17,500 |
$17,501 |
$21,000 |
$21,001 |
$24,500 |
$24,501 |
$28,000 |
$28,001 |
and over |
|
3 |
$ 0 |
$17,600 |
$17,601 |
$22,000 |
$22,001 |
$26,400 |
$26,401 |
$30,800 |
$30,801 |
$35,200 |
$35,201 |
and over |
|
4 |
$ 0 |
$21,200 |
$21,201 |
$26,500 |
$26,501 |
$31,800 |
$31,801 |
$37,100 |
$37,101 |
$42,400 |
$42,401 |
and over |
|
5 |
$ 0 |
$24,800 |
$24,801 |
$31,000 |
$31,001 |
$37,200 |
$37,201 |
$43,400 |
$43,401 |
$49,600 |
$49,601 |
and over |
|
6 |
$ 0 |
$28,400 |
$28,401 |
$35,500 |
$35,501 |
$42,600 |
$42,601 |
$49,700 |
$49,701 |
$56,800 |
$56,801 |
and over |
|
7 |
$ 0 |
$32,000 |
$32,001 |
$40,000 |
$40,001 |
$48,000 |
$48,001 |
$56,000 |
$56,001 |
$64,000 |
$64,001 |
and over |
|
8 |
$ 0 |
$35,600 |
$35,601 |
$44,500 |
$44,501 |
$53,400 |
$53,401 |
$62,300 |
$62,301 |
$71,200 |
$71,201 |
and over |
|
9 |
$ 0 |
$39,200 |
$39,201 |
$49,000 |
$49,001 |
$58,800 |
$58,801 |
$68,600 |
$68,601 |
$78,400 |
$78,401 |
and over |
|
10 |
$ 0 |
$42,800 |
$42,801 |
$53,500 |
$53,501 |
$64,200 |
$64,201 |
$74,900 |
$74,901 |
$85,600 |
$85,601 |
and over |
To apply, submit the following:
A copy of the front page of your most recent income tax return or a copy of your last two most recent pay-stubs, if you didn't file an income tax return.
A completed Sliding Fee Program application. Applications are available at any of our clinic locations - just inquire at the front desk. All information we receive from you is strictly confidential and in compliance with HIPPA regulations and will be processed immediately.
If you have any questions, please ask any of our staff.
Download Sliding Fee Application by clicking the link below.