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 any applicable form of income, as listed below, for each 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
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)