To help our patients afford healthcare services, we offer a sliding fee discount based on income verification and income base eligibility. Here are some important things to know:
Determining eligibility
A Family Health Source employee will review the patient’s family size, income, and other data following the Federal Poverty Guidelines to help determine medical fees. Services will not be denied to any patient based on their inability to pay, or citizenship status.
Procedure
We offer discounts on medical services from partial payments up to 100% full coverage. All employees involved in our patient’s care will work to assess which scale they are eligible for. Please note that this is not an insurance plan—it is a discount program valid only at Family Health Source locations.
Income-related documents
The following documents are required to determine eligibility and process discount fees:
- Filed Tax Returns (1040)
- W-2 or 1099 (must be accompanied by 4506-T form)
- Most recent 4 weeks' worth of paystubs
- Social Security, SSI, SSDI, or other benefit award letter
- Notarized Verification of Support (must be accompanied by 4506-T form)
- Notarized Self-Declaration of Income (must be accompanied by 4506-T form)
Other forms of income may include:
- Social Security Award Letter
- VA Benefits
- Pension
- IRA
- Child Support
- Disability
- Unemployment benefits award letter*
* valid for 12 months
Click here to schedule your appointment with one of our Outreach specialists.