Sliding Fee Scale Program

At Hope, our mission is to provide excellent, compassionate care to everyone - regardless of their ability to pay.

In order to accomplish this we offer our patients a Sliding Fee Scale that allows us to reduce or “slide” fees for their care. We determine eligibility based on the patient’s income level, family size and where they fall within the Federal Poverty Guidelines.

 

Patients who are at 100% of the Federal Poverty Level receive a full discount and pay only a nominal $40 fee for services. Patients between 101-200% of the FPL also receive partial discounts. Patients at and above 201% of the FPL do not receive a discount for care and pay the full charge amount.

 

Any patient can apply for the Sliding Fee Discount Program (SFDP), whether they are uninsured, underinsured, or have commercial insurance. Patients who have insurance and who also qualify for the SFDP will pay whichever amount is less. If an insured patient applied for the SFDP and was determined to be at 100% of the Federal Poverty Level (FPL), the patient would qualify for a full Sliding Fee Scale discount. If the patient’s insurance required a $50 copay for the appointment they would pay the lesser of the two amounts. In this example they would pay the $40 nominal fee instead of the $50 copay.

 

Please see the graphic below for further information. 

 

You can apply for the Sliding Fee Discount Program at any time. The verification process only takes a few minutes and can be completed in our office. Please bring proof of income such as a prior year W2, two most recent pay stubs, letter from employer, or Form 4506-T (if W-2 not filed). Individuals who are self-employed will be required to submit information on the most recent three months of income and expenses for the business. 

Poverty Guidelines

Persons in family/household
Poverty guideline
1
$12,880
2
$17,420
3
$21,960
4
$26,500
5
$31,040
6
$35,580
7
$40,120
8
$44,660