Payment
Accepted Forms of Payment
Family Health Centers, Inc. accepts cash, check, Visa, MasterCard, or Discover, most forms of insurance, Medicare, and Medicaid.
Sliding Fee Scale
For people without insurance we base our charges on a sliding fee scale. Proof of one month’s worth of income is required to determine the fees for services rendered.
The sliding fee scale is based on the Federal Poverty Guidelines. Visit: http://aspe.hhs.gov/POVERTY/ for more information.
Medical
| FAMILY HEALTH CENTERS, INC. 2018 MEDICAL SLIDING FEE SCALE EFFECTIVE: FEBRUARY 27, 2018 |
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| Payment Category |
F | E | D | C | B | A | |
| Discount on Charges |
100% | 80% | 60% | 40% | 20% | None | |
| Poverty Level |
Under 100% | 101% – 125% | 126% – 150% | 151% – 175% | 176% – 200% | 201% – over | |
| # Persons in Household |
Household Incomes |
||||||
| 1 | Annual | $0 – $12,140 | $12,141 – $15,175 | $15,176 – 18,210 | $18,211 – $21,245 | $21,246 – $24,280 | $24,281 – over |
| 2 | Annual | $0 – $16,460 | $16,461 – $20,575 | $20,576 – $24,690 | $24,691 – $28,805 | $28,806 – $32,920 | $32,921 – over |
| 3 | Annual | $0 – $20,780 | $20,781 – $25,975 | $25,976 – $31,170 | $31,171 – 36,365 | 36,366 – 41,560 | $41,561- over |
| 4 | Annual | $0 – $25,100 | $25,101 – $31,375 | $31,376 – $37,650 | $37,651 – $43,925 | 43,926 – 50,200 | $50,201- over |
| 5 | Annual | $0 – $29,420 | $29,421 – $36,775 | $36,776 – $44,130 | $44,131 – $51,485 | $51,486 – $58,840 | $58,841 – over |
| 6 | Annual | $0 – $33,740 | $33,741- $42,175 | $42,176 – $50,610 | $50,611 – 59,045 | 59,046 – 67,480 | $67,481 – over |
| 7 | Annual | $0 – $38,060 | $38,061 – $47,575 | $47,576 – $57,090 | $57,091 – $66,605 | 66,606 – 76,120 | $76,121- over |
| 8 | Annual | $0 – $42,380 | $42,381 – $52,975 | $52,976 – $63,570 | $63,571 – $74,165 | 74,166 – 84,760 | $84,761 – over |
Notes:
- For each additional household member add $4,320 to annual income.
- Sliding fee scale based upon total gross household income and the number of persons residing in the household.
- For under 100% of the FPL there is a 100% discount and the following Nominal fee:
- Nominal Fee for Categroy F is:
- Medical office visit & any procedure which cost is included in the FQFC rate: $25.00
- Minor surgical procedures & laboratories not included in the FQHC rate: $25.00 plus cost of procedure.
- Health Educations: $20.00
- Nominal Fee for Categroy F is:
Lab, Dental, Pharmacy
| FAMILY HEALTH CENTERS, INC. 2018 LAB, DENTAL, PHARMACY SLIDING FEE SCALE EFFECTIVE: FEBRUARY 27, 2018 |
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| Payment Category |
F | D | C | B | A | |
| Discount on Charges |
100% | 99% | 66% | 33% | 0% | |
| Poverty Level |
Under 100% | 101% – 150% | 151% – 175% | 176% – 200% | 201% – over | |
| # Persons in Household |
Household Incomes |
|||||
| 1 | Annual | $0 – $11,880 | $11,881 – $17,820 | $17,821 – $20,790 | $20,791 – $23,760 | $23,761 – over |
| 2 | Annual | $0 – $16,020 | $16,021 – $24,030 | $24,031 – $28,035 | $28,036 – $32,040 | $32,041 – over |
| 3 | Annual | $0 – $20,160 | $20,161 – $30,240 | $30,241 – $35,280 | $35,281 – $40,320 | $40,321 – over |
| 4 | Annual | $0 – $24,300 | $324,301 – $36,450 | $36,451 – $42,525 | $42,526 – $48,600 | $48,601 – over |
| 5 | Annual | $0 – $29,420 | $29,421 – $44,130 | $44,131 – $51,485 | $51,486-$58,840 | $58,841 -over |
| 6 | Annual | $0 – $32,580 | $32,681 – $48,870 | $48,871 – $57,015 | $57,016 – $65,160 | $65,161 – over |
| 7 | Annual | $0 – $36,730 | $36,731 – $55,095 | $55,096 – $64,278 | $64,279 – $73,460 | $73,461 – over |
| 8 | Annual | $0 – $40,890 | $40,891 – $61,335 | $61,336 – $71,558 | $71,559 – $81,780 | $81,781 – over |
Notes:
- For each additional household member add $4, 320 to annual income.
- Sliding fee scale based upon total gross household income and the number of persons residing in the household.
- For under 100% of the FPL there is a 100% discount and the following Nominal fee:
- Nominal Fee for Category F is:
- Medical office visit and any procedure which cost is included in the FQHC rate $25.00
- Minor surgical procedures and laboratories not included in the FQHC rate $25.00 plus cost of procedure
- Health Education, Behavior Health, Vision, and Medication Therapy Management $20.00
- Nominal Fee for Category F is:
