5367739.jpg

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.

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 on 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:

  • 30 Days of Paystubs

  • Official Documentation of Child Support

  • Official Documentation of Alimony

  • Notarized letter from the patient's employer in the case of contract work.

  • Official Unemployment Documentation

  • State Aid Approval Letter (must include the 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.

Nominal Fee Schedule 

2022 Nominal Fee Schedule Services Index.jpg

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.  Group Therapy (FSS)

9.  Restored Paths (in-scope services only)

10. Co-Payments

11. Deductibles

2022 Sliding Fee Scale.jpg

View or download Sliding Fee Application