Sliding Fee

Sliding Fee Program

Through funding from the U.S. Bureau of Primary Health Care, we offer a Sliding Fee Program. This program is based on income and family size and reduces the amount you pay for health center services. If you qualify, you may pay only 20 – 80% of the cost for most services. You may be eligible for this program even if you have insurance. Applications are available in the waiting and exam rooms at each clinic. All applications are confidential. Our case workers will help you fill the forms.

Reduced Fee Form: Federal Poverty Guideline will be used for the Sliding Fee Program. If your income falls within the guidelines, we encourage you to apply. A Slide Card will be issued and needs to be presented at the time of your visit.

2010 Sliding Fee Scales: Medical | Dental

Applications are available in the waiting and exam rooms at each clinic. All applications are confidential. Our case workers will help you fill the forms.

Federal Poverty Guideline will be used for the Sliding Fee Program. If your income falls within the guidelines, we encourage you to apply.

Proof of income is required to process your application. A copy of a current Federal Income Tax Return is strongly encouraged as proof of income. However, documents listed below are also acceptable:

General Assistance

• Workers’ Compensation
• W-2 forms
• Income tax returns
• Social Security notice
• Pension notice
• College Students; parents income
• Current pay stubs
• Unemployment award notice
• Alimony/child support
• Letter from employer

You will receive a letter and a card valid for a year from the Sliding Fee Coordinator within 10 days of our receipt of your completed Sliding Fee application. A completed application includes your proof of income documents.

Questions?

Contact:

Sliding Fee Coordinator under our Billing Department
Phone:410-651-3354
12137 Elm Street, PO Box 191
Princess Anne MD 21853