WebI have been given a Sliding-Fee Application, which I will complete and submit to Health First CHC along with my proof of income in order to apply for the Sliding-Fee Scale Discount for any future visits. Patient/Guarantor Signature: _____ Date: _____ For Office Use Only: Eligible for Sliding Scale: WebTo apply for our sliding fee scale, please contact us at (307) 233-6000 (select option #2) to discuss documentation needed for eligibility. Below are some commons forms of …
Chapter 16: Billing and Collections Bureau of Primary Health Care
WebSliding Fee Scale Our sliding fee scale (income chart on next page) is available at our Canton, Gouverneur, Ogdensburg and Malone healthcare centers. This is for anyone who has a household income at or below 200% of the Federal Poverty Guidelines. A “household” includes all people living in the same house or apartment even if not related to you. WebISLAND HEALTH CARE CHC 2024 SLIDING FEE SCALE AND HEALTH SAFETY NET (HSN) DEDUCTIBLE ISLAND HEALTH CARE At or <100% Fed Pov Level <125% Fed Pov Level <150% Fed Pov Level <175% Fed Pov Level <200% Fed Pov Level Partial HSN <300% Fed Pov Level katakis physical medicine
Sliding Fee Scale - High Plains Community Health Center
WebIn order to get reduced or free services from some clinics, they use a sliding fee scale based on your income.When they use a sliding fee scale, the 100% rate can be different than 100%. In those cases, using for example a 200% federal poverty level, you will only need double the 100% number listed above to 200%. ... CHC Lynnwood Clinic is a ... WebSliding Fee Scale Our sliding fee scale (income chart on next page) is available at our Canton, Gouverneur, Ogdensburg and Malone healthcare centers. This is for anyone … WebIdentify the Sliding Fee Scale Amount based on the above step. EXAMPLE 1: A 1 person Household (H/H) with an annual income of $14,580 or below, would be eligible for SLIDE A, which means the patient out of pocket fee for service will be $0.00. EXAMPLE 2: A 3 person Household (H/H) with an annual income between $31,075 - $37,290, would be ... lawyer lawless ซับไทย