Patient Discounts

Patient Discounts under the Sliding Fee Discount Program are designed to assist qualified patients in reducing their bills for health services and prescriptions. These are available for all our health centers and pharmacies. (Patients are our priority. Our health centers serve all patients regardless of their ability to pay.)

Sliding Fee Application

 

Who Can Apply? How Are They Eligible?


Anyone can apply. Eligibility is based on family size and income for those at or below 200% of the Federal Poverty Level.

 

What Services Are Covered?


The following services are covered under the discount program:

  • Medical
  • Behavioral
  • Basic Dental
  • Psych Testing
  • Vision
  • Surgical
  • Dental Appliances/Cosmetic
  • Select Glasses/Frames/Lenses
  • Hearing Aids
  • Prescriptions

 

When and What Am I Expected To Pay?


Find where you fall on the scale. Once you locate your Slide (A, B, C or D), you will see the amount expected at the time of service as you move down the chart.

Determining Your Sliding Fee Payment Class. You are in Class A if you family size is 1 and your income is equal to or less than$12, 060, family size is 2 and your income is equal to or less than$16,240, family size is 3 and your income is equal to or less than$20, 420, family size is 4 and your income is equal to or less than$24,600, family size is 5 and your income is equal to or less than$28,780, family size is 6 and your income is equal to or less than$32,960, family size is 7 and your income is equal to or less than$37,140, family size is 8 and your income is equal to or less than $41,320. You are in Class B if you family size is 1 and your income is between $12, 061-$16,040, family size is 2 and your income is between $16,241-$21,600, family size is 3 and your income is between $20,421-$27,159, family size is 4 and your income is between $24,601-$32,718, family size is 5 and your income between $28,781-$38,277, family size is 6 and your income is between $32,961-$43,837, family size is 7 and your income is between $37,141-$49,396, family size is 8 and your income is between $41,321-$54,956. You are in Class C if you family size is 1 and your income is between $16,041-$20,020, family size is 2 and your income is between $21,601-$26,960, family size is 3 and your income is between $27,160-$33,897, family size is 4 and your income is between $32,719-$40,836, family size is 5 and your income between -$38,278-$47,775, family size is 6 and your income is between$43,838-$54,714, family size is 7 and your income is between $49,397-$61,652, family size is 8 and your income is between $54,957-$68,591. You are in Class D if you family size is 1 and your income is between $20,021-$24,120, family size is 2 and your income is between $26,961-$32,480, family size is 3 and your income is between $33,898-$40,840, family size is 4 and your income is between $40,837-$49,200, family size is 5 and your income between -$47,776-$57,560, family size is 6 and your income is between $54,715-$65,920, family size is 7 and your income is between $61,653-$74,280, family size is 8 and your income is between $68,592-$82,640. If you are Class A, with each of these visits you are expected to pay $20 medical, $20 behavioral, $20 audiology, $85 basic dental, $85 psych testing, $65 vision, and $100 surgical. If you are Class B, with each of these visits you are expected to pay $40 medical, $40 behavioral, $40 audiology, $90 basic dental, $90 psych testing, $90 vision, and $200 surgical. If you are Class C, with each of these visits you are expected to pay $60 medical, $60 behavioral, $60 audiology, $100 basic dental, $100 psych testing, $100 vision, and $300 surgical. If you are Class D, with each of these visits you are expected to pay $75 medical, $75 behavioral, $75 audiology, $115 basic dental, $115 psych testing, $115 vision, and $400 surgical. If you are Class A, with each of these services you are expected to pay a nominal fee of $500.00 plus a discount of 30% of charges over the nominal fee for dental appliances/cosmetic, nominal fee of $75.00 plus a discount of 50% of charges over the nominal fee for select glasses/frames & lenses (excludes lens enhancements), nominal fee of $500.00 plus a discount of 40% of charges over the nominal fee for hearing aids (excludes batteries), and nominal fee of $4 plus a discount of 50% of charges over the nominal fee for prescriptions. If you are Class B, with each of these services you are expected to pay a nominal fee of $500.00 plus a discount of 25% of charges over the nominal fee for dental appliances/cosmetic, nominal fee of $75.00 plus a discount of 40% of charges over the nominal fee for select glasses/frames & lenses (excludes lens enhancements), nominal fee of $500.00 plus a discount of 35% of charges over the nominal fee for hearing aids (excludes batteries), and nominal fee of $4 plus a discount of 40% of charges over the nominal fee for prescriptions. If you are Class C, with each of these services you are expected to pay a nominal fee of $500.00 plus a discount of 20% of charges over the nominal fee for dental appliances/cosmetic, nominal fee of $75.00 plus a discount of 30% of charges over the nominal fee for select glasses/frames & lenses (excludes lens enhancements), nominal fee of $500.00 plus a discount of 30% of charges over the nominal fee for hearing aids (excludes batteries), and nominal fee of $4 plus a discount of 30% of charges over the nominal fee for prescriptions. If you are Class D, with each of these services you are expected to pay a nominal fee of $500.00 plus a discount of 15% of charges over the nominal fee for dental appliances/cosmetic, nominal fee of $75.00 plus a discount of 20% of charges over the nominal fee for select glasses/frames & lenses (excludes lens enhancements), nominal fee of $500.00 plus a discount of 25% of charges over the nominal fee for hearing aids (excludes batteries), and nominal fee of $4 plus a discount of 20% of charges over the nominal fee for prescriptions.

 

What Do Participants Pay?


PER VISIT: Participants in Slide A pay a NOMINAL fee. Those in Slide B-D pay an established fee.

PER CHARGE: All participants receive a discount (based on payment class) on the charges ABOVE the nominal fee. At the time of visit, they will pay the discounted balance PLUS the nominal fee.

 

How Can I Apply?


PAPER: Ask for and complete a paper application at your local health center, making sure to include income verification documents. If you have no proof of income, send a Self Declaration letter that you receive no income.

ONLINE: Fill out a Sliding Fee Application. Income verification documents are required before you submit.  If you have no proof of income, please legibly write on paper verifying you have no income source, sign and date. Documents can be taken as a photo on mobile devices and uploaded from there.

 

Tips On Filling Out The Application


What is my household income?
List individuals you claim on your taxes. If you cannot claim them as a dependent, do not list them on your application, unless it is your spouse and you file taxes separately.

How can I verify my income?
Documents that can be used to verify your income include:

  • Most Recent Tax Return
  • W-2
  • 1 Month of Pay Stubs
  • 1 Unemployment Stub
  • Government Assistance Statement
  • Alimony
  • Denials from Other Assistance

 

How Will I Know If My Application Is Approved?


If eligibility is approved, you will receive a letter and sliding fee card in the mail. The patient’s eligibility will be in effect for one year from the application. Any charges incurred at Valley Health during the three months prior to the approval day will be adjusted.