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. 2016 MEDICAL SLIDING FEE SCALE EFFECTIVE: APRIL 1, 2016 |
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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 – $11,880 | $11,881 – $14,850 | $14,851 – $17,820 | $17,821 – $20,790 | $20,791 – $23,760 | 23,761 – over |
| 2 | Annual | $0 – $16,020 | $16,021 – $20,025 | $20,026 – $24,030 | $24,031 – $28,035 | $28,036 – $32,040 | $32,041 – over |
| 3 | Annual | $0 – $20,160 | $20,161 – $25,200 | $25,201 – $30,240 | $30,241 – $35,280 | $35,281 – $40,320 | $40,321 – over |
| 4 | Annual | $0 – $24,300 | $24,301 – $30,375 | $30,376 – $36,450 | $36,451 – $42,525 | $42,526 – $48,600 | $48,601 – over |
| 6 | Annual | $0 – $32,580 | $32,581 – $40,725 | $40,726 – $48,870 | $48,871 – $57,015 | $57,016 – $65,160 | $65,161 – over |
| 7 | Annual | $0 – $36,730 | $36,731 – $45,913 | $45,914 – $55,095 | $55,096 – $64,278 | $64,279 – $73,460 | $73,461 – over |
| 8 | Annual | $0 – $40,890 | $40,891 – $51,113 | $51,114 – $61,335 | $61,336 – $71,558 | $71,559 – $81,780 | $81,781 – over |
Notes:
- For each additional household member add $4,160 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:
Dental
| FAMILY HEALTH CENTERS, INC. 2016 DENTAL SLIDING FEE SCALE EFFECTIVE: APRIL 1, 2016 |
||||||
| 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 |
| 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 $4,160 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:
- Dental Visit: $25.00 for office visit plus dental lab & supplies. Nominal fee does not apply to cosmetic or elective procedures (i.e. implants vs dentures).
- Pharmacy: $5.00 dispensing fee cost of medication.
- X-Ray: $20.00 per visit plus cost of equipment, supplies and readings.
- Nominal Fee for Categroy F is:
