Uninsured Income-based Payment Program

Medical Professional taking blood pressurerTo 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 to help determine medical fees. 


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:

  • A valid driver’s license or state-issued picture ID 
  • Federal income tax return valid on or before April 15th of the following year
  • Paystub (most recent) showing one month’s income*
  • Unemployment benefits award letter*
  • Letter from employer on official business letterhead*
  • Notarized verification of financial support*
  • Self-declaration of income statement*

Other forms of income may include:

  • Social Security Award Letter
  • VA Benefits
  • Pension
  • IRA
  • Child Support
  • Disability 

* valid for 12 months


Click here to schedule your appointment with one of our Outreach specialists.

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