Sliding Fee Scale - Your Questions Answered
Confession: there are things in life I politely nod my head to saying, “yes, that’s perfectly clear” with no EARTHLY IDEA what it means. Sliding fee scale was one of those things. If you fall into this category you’re not alone - one of the biggest questions our front desk gets is about sliding fee scale.
The most important thing to remember is that no one will be turned away because of his or her inability to pay. Read on for information that will leave you nodding your head with confidence next time sliding fee scale is mentioned because… you really get it this time.
What It Is
Pushmataha Family Medical Centers (PFMC) in Clayton and Boswell are partially federally funded. These programs, along with many others, were developed to give healthcare to folks who can’t afford it, in addition to serve those who can.
Sliding fee scale literally means your rate for medical service slides up and down depending on your household income.
Who It Covers
The Sliding Fee Scale is available to EVERYONE! Even if you have insurance. If you have insurance and qualify for a Sliding Fee Discount (info below) we will reduce your out-of-pocket expense after insurance to the amount you would pay according to your Sliding Fee Discount. This benefits ALL of our patients. Also, if you don’t have insurance coverage, come see us. We can assist you with the Marketplace, Medicaid, and Sliding Fee Scale applications.
How It Works
Each year the Federal Register sets poverty guidelines – income amounts defined as poverty level. So for 2017, a single person living alone earning $12,060 or below is considered poverty level. This number depends on the amount of people in each household. Details are listed at the Federal Register Website.
Assistance is offered to anyone who is at 200% or below the poverty line amount.
Patients who qualify are charged a small fee for medical, dental, and vision services. *Right now dental and vision are available at the Clayton clinic only.
Sliding fee scale also helps Medicare patients with their co-insurance. Depending on household earnings, this service may cover what Medicare doesn’t.
Patients who are not eligible for sliding fee scale are also welcome. They’ll pay with insurance or the full rate of the medical service like they would at any other clinic.
How To Qualify
We only offer sliding fee scale benefits to those with proof of household income, so there’s a little homework involved. Household income is determined by income documentation (proof of income) from each household member that contributes financial resources – including room and board.
You can prove this with the following documents:
For government assistance/social security: DHS paper that states how much you get monthly.
Bring these documents to the clinic or email us at: firstname.lastname@example.org PFMC does not contact employers, government agencies, or utility offices for this information.
*For special circumstances speak to our financial assistant.
What It Covers
If you have insurance, sliding fee scale covers services that your insurance doesn’t cover. If you don’t have insurance, it covers your services.
There are instances when lab work or x-rays need to be sent off to another agency. This is a separate service not connected to the clinic so it’s billed separately. These services also offer a sliding fee discount but it may not be the same as our in-house discount.
When You Qualify
The PFMC business office is here to serve you! They explain everything from what scale you qualify for to the percentage you’re expected to pay.
Much like copay, you’ll have a fee due at every office visit. This may or may not cover the full amount of the service. If it doesn’t, you’ll receive a bill for the remaining amount. All of this will be discussed ahead of time so there shouldn’t be any surprises.
Hopefully this helps you understand the process of sliding fee scale. If we missed anything, post your question in the comment section and we’ll get back to you ASAP!
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