Sliding Fee Scale &
Discount Policy

Sliding Fee Discount

Family Health Centers, Inc. (FHC), Sliding Fee Discount Program will be provided to eligible persons based on the patient's ability to pay. Ability to pay is determined by the household size and annual income relative to a discount schedule based on federal poverty income guidelines. A patient will not be denied service(s) due to their inability to pay.

Sliding Fee Scale Application

All patients are eligible to complete sliding fee scale

Notice of Non-Discrimination

For people without insurance we base our charges on a sliding fee scale. Proof of one month's worth of income is required to determine the fees for services rendered.

The sliding fee scale is based on the Federal Poverty Guidelines. Visit: for more information.

Sliding Fee Calculator


Self-pay patients are those who must pay all or part of the cost of the care. To assure access to health care services, uninsured or full payment self-pay patients will receive a discount on charges based on the individual or family income.

Discount Policy

  1. The Director of Finance obtains the updated federal poverty income guidelines from the Federal Register annually and updates the sliding fee discount schedule.
  2. In conjunction with the discount schedule review, the policies and procedures related to administration of the sliding fee discount program will be reviewed and updated if needed.
  3. The annual update to the sliding fee discount schedule and any policy updates proposed will be presented to the Finance Committee of the Board of Directors for review. After Finance Committee review, the discount schedule and policy updates will be presented to the Board of Directors for review and approval. FHC staff will ensure that patients are informed about availability of the sliding fee discount program at the time of new patient registration.
  4. FHC will issue periodic reminders to patients regarding availability of the sliding fee discount program through lobby signs, printed messages on billing statements, and other appropriate communications.
  5. Financial Service Representative (FSR) is to collect the sliding fee scale minimum amount at the time of service from patients who have been certified within the last twelve (12) months. Patients without the minimum will be expected to bring their payment at their next visit; if not, payment is brought to the second visit; these patients will be triaged and non- emergency patients will be rescheduled until the patient's balance is paid.
  6. Using the sliding fee scale application and the presented income documentation, the FSR may determine the patient's applicable sliding fee scale percentage and complete the Sliding Fee Eligibility Form based upon the following information provided by the patient:
    1. Patient Name
    2. Patient Social Security Number
    3. Patient Family Size
    4. Patient Income Level
    5. Patient Payday Cycle
  7. The Patient must sign and date the Sliding Fee Eligibility Form which will be scanned into the Patient Management System (PMS). The hard copy will be filed in chronological order and kept for three (3) years in the Billing Office.
  8. The FSR or Financial Counselor will sign as a witness. The patient will be subject to a random audit to provide documentation of evidence indicated on the Sliding Fee Scale Application. FSRs must attach a copy of the document provided to confirm eligibility. The application is good for one (1) year and must be renewed annually.
  9. Patients unable or unwilling to provide any level of documentation are not eligible to participate in the program and will be required to pay 100% of their charges, until such time as they provide documentation. At the time documentation is provided, any eligible discount will be applied to previous service retroactively up to thirty (30) days.
  10. Patients applying for the sliding fee discount will be informed that they are obligated to contact FHC if their income or household status changes.
  11. Patients whose documentation qualifies them for the minimum payment are expected to apply for Medicaid/Medicare. If positive verification is received, those visits become insured. If negative verification is received, the visits remain at the minimum category patients pay.
  12. The discount on charges is available for all services covered under the FHC scope of service. Multiple sliding fees scales will be used to cover all the services in scope.
  13. Services not on the scope of services will be paid in full and, in some instances, may be required to be paid in advance. (Foe example: Dentures & Minor Surgery)
  14. FHC will notify patient prior to expiration of sliding fee eligibility.