Sliding Fee Program

Sliding Fee Program:

It is the mission of Heritage Health to provide affordable medical, dental and mental health services for the community without regard to a person’s ability to pay. Patients will have the opportunity to discuss their payment options at the time of check-in at the health center or afterward with one of our financial consultants.

Heritage Health accepts a wide range of medical and dental insurances. Patients with insurance plan(s) are expected to pay the co-payment amount that has been established by their insurance company at the time of service. Heritage Health will bill a patient’s insurance for all services; patients may be responsible for additional expenses not covered by their insurance company. Patients may also be eligible for our sliding fee discount that can be applied to the outstanding balance as long as doing so is not prohibited by our contract with the insurance carrier. We will make every attempt to help patients understand their coverage, charges, and discounts available to them.

Sliding Fee Discount:
All patients are eligible for our sliding fee scale. A sliding fee scale means that fees charged to you for services provided may be discounted based upon household income and family size. These discounts are available to patients based on the guidelines provided annually by the federal government. To apply and qualify for the sliding fee scale we will need (one) of the following listed below for each applicable member of the household:

Diagnostic Services

We offer a full range of diagnostic services.

Wellness Care

Wellness visits are a great way to make sure you are as healthy as you feel. They can focus on goals like achieving a healthy weight, proper nutrition and encourage a lifestyle change that improves health. Your PCP will work with you to build a plan for your goals and ongoing healthcare needs.

Routine Medical Care

Your PCP will be able to help you through your routine medical care needs. These may include diseases and symptoms like a cough, cold, fever, or flu. Other examples of Routine Medical services are annual physicals, health coaching, and smoking cessation, all available through your Heritage Health Primary Care Provider.

Minor Surgery

Heritage Health offers several minor outpatient procedures as a way of providing more services at a single site and at a discounted price. Talk with your Heritage Health care team about our expanding list of services, including lacerations, orthopedics, circumcisions, mole removals, and more.

Chronic Disease Management

Includes conditions like hypertension, diabetes, pain, and other chronic diseases. Subspecialty teams have been created to provide you with specialty care when needed and will work together with your PCP. For patients with multiple chronic diseases, Heritage Health also offers Outpatient Intensive Care services.

Women’s Health

At Heritage Health we are proud to offer women of all ages specialized services by experts in women’s health. Our services include mammography, colposcopies, IUD placements, etc. Connect with a provider to find out what options best fit your unique needs.

30 Days of Paystubs

Official Documentation of Child Support

Official Documentation of Alimony

Notarized Letter from the Patients Employer in the case of Contract Work

Official Unemployment Documentation

State Aid Approval Letter (must include amount of income)

Social Security Benefit Form

Please provide these documents at the time of your appointment as we will be unable to apply any discounts without proper documentation. If you find that you are unable to pay for your care we want to help. There are multiple options available to help you. Please contact our billing office if you would like to find out more. You will not be refused care based on your ability to pay for services.

*Due to the high cost of supplies, patients will be required to pre-pay their portion before being allowed to schedule Dental Restorative Services. All other services are available without the pre-payment requirement. Please contact us if you have any questions.

Sliding Fee Discount Groups for Medical + Psychiatric Services

Based on family size and household income
Fam. SizeGroup 1
Group 2
Group 3
Group 4
Group 5
Group 6
1$0 - 12,880.00$12,880.01 - 17,130.40$17,130.41 - 19,320.00$19,320.01 - 22,540.00$22,540.01 - 25,760.00$25,760.01 +
2$0 - 17,420.00$17,420.01 - 23,168.60$23,168.61 - 26,130.00$26,130.01 - 30,485.00$30,485.01 - 34,840.00$34,840.01 +
3$0 - 21,960.00$21,960.01 - 29,206.80$29,206.81 - 32,940.00$32,940.01 - 38,430.00$38,430.01 - 43,920.00$43,920.01 +
4$0 - 26,500.00$26,500.01 - 35,245.00$35,245.01 - 39,750.00$39,750.01 - 46,375.00$46,375.01 - 53,000.00$53,000.01 +
5$0 - 31,040.00$31,040.01 - 41,283.20$41,283.21 - 46,560.00$46,560.01 - 54,320.00$54,320.01 - 62,080.00$62,080.01 +
6$0 - 35,580.00$35,580.01 - 47,321.40$47,321.41 - 53,370.00$53,370.01 - 62,265.00$62,265.01 - 71,160.00$71,160.01 +
7$0 - 40,120.00$40,120.01 - 53,359.60$53,359.61 - 60,180.00$60,180.01 - 70,210.00$70,210.01 - 80,240.00$80,240.01 +
8$0 - 44,660.00$44,660.01 - 59,397.80$59,397.81 - 66,990.00$66,990.01 - 78,155.00$78,155.01 - 89,320.00$89,320.01 +

Nominal Fee Schedule

See below for index
Level A | 0% - 100%Level B | 133% Level C | 150% Level D | 175% Level E | 200% Over 200%
Group 1Group 2Group 3 Group 4 Group 5 Group 6
1$25$35$45$55$65Full Fee
2Flat Fees for test & procedure graduated for each Discount Level (see the schedule of fees). Full Fee
3100% Discount 50% Discount 40% Discount 30% Discount 20% Discount Full Fee
4$2 $4$6$8$10Full Fee
5Flat Fees for procedure graduated for each Discount Level (Heritage Health Dental Fee + Discount Schedule).Full Fee
6$15$20$25$230$40Full Fee
7$25$35$45$55#65Full Fee
8$5$6$7$8$9Full Fee
9Lesser of the copayment or the flat fee based on the Discount Level and service rendered. Full Fee
10Lesser of the outstanding deductible or the flat fee based on the Discount Level and service rendered.Full Fee

*Nominal Fee Schedule Services Index

  1. Medical, MAT, or Psychiatric Visits

  2. Medical Test/Procedure(s)

  3.  Laboratory Tests | LabCorp

  4. Shared Medical Appointments

  5. Dental Visits

    Preventative/Emergent Services, Restorative Services, Dental Products

  6. Counseling/Dietitian Visits

  7. Pain Management

  8.  Medication Assistance Program (MAP) | Group Therapy (FSS)

  9. Copayments

  10. Deductibles

View or download Sliding Fee Documentation here.