Discounted Medical & Dental Care
The Sliding Fee Discount Program ensures that quality health care is available for low and moderate-income families. Healthy Connections, Inc. has established a system for discounting medical and dental care for eligible families. In order to serve the greatest number of families in need, there are clear income and asset limits for eligibility for the sliding fee schedule.
The Sliding Fee Discount policy is a privilege provided to our clients. Federal law requires that we maintain current and accurate documentation to verify your eligibility. The final determination of eligibility rests solely within Healthy Connections. If you are not satisfied with the determination in your case, you may file an appeal with the Grievance Committee of the Board of Directors.
- Discounted medical and dental care is based on your family’s gross income and number of persons living in a domicile. The guidelines are established by the Healthy Connections, Inc. Board of Directors annually.
- If you elect to use our contract pharmacies, you will receive a discount from normal commercial pricing.
- You may have your discount category recalculated at any time your family gross income changes significantly.
- If you believe your discount category was incorrectly determined, you may schedule an appointment with the Chief Financial Officer or Chief Executive Officer for case review.
- After initial qualification for sliding fee discounts, you must requalify every six months by presenting proof of income and verification of family size to the Financial Counselor in the clinic you use. If an annual tax return or Medicaid award letter is provided for assessment then you requalify every year.
- You must keep your account current according to the terms of your payment arrangement. Past due accounts in excess of 90 days will not be eligible for discounts until the account is brought current or special arrangements have been established by the Financial Counselor.
- If your family’s gross income changes by 10% or more during any six-month qualification period, you must bring new proof of income and family size to have your discount category recalculated.
- It is YOUR responsibility to keep your sliding fee discount program status current. Healthy Connections, Inc. is not authorized to grant exceptions. Services provided while your discount status is not current must be charged at full price. HCI cannot back date requalification’s.
Dental Discounts – Full price charges may be reduced by as much as 50% depending upon the family’s sliding fee category.
Family Size – Includes all family; children and adults living in a traditional or non-traditional family unit. Transitional situations will be assessed on an individual basis.
Family Income – Includes the gross incomes of all persons living in traditional or non-traditional family units. Transitional situations will be assessed on an individual basis.
Gross Income – Before tax income from all sources for every earner in the domicile. Gross income includes earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources. Non-included income is noncash benefits such as food stamps and housing subsidies.
Medical Discounts – Full price charges may be reduced to the current basic office fee depending upon the family’s sliding fee discount category.
No Income Statements – A family with “zero income” must sign a “No Income Statement.” This is a legally binding document in which false statements constitute fraud. By signing a “No Income Statement” the family gives HCI permission to access the Internal Revenue Service for the latest federal income tax return.
Proof of Income – Verification provided by employers or the government is the only acceptable proof of income. Examples include recent pay slips, most recent annual tax return filed government benefit statements, DHS statements, Medicaid award letter, bank statements (only used to show direct deposit of Federal social security, disability or state deposits) or signed letters from employers. Verbal estimates are NOT acceptable. Self-employed patients are required to provide tax returns and bank statements are not required or allowed.
Underinsured – Patients that have medical insurance plans with an annual deductible of $1,000.00 or greater are considered underinsured and may be eligible for discounted medical services.
To qualify to receive a discount the following must occur:
- You must present your insurance identification card at the time of service whereas HCI shall bill the insurance for charges incurred this day.
- Explanation of Benefits (EOB) reports that provides the details of whether the benefits were paid or not are received by the billing department. The EOB provides information as to the status of the claim, which includes payments made or if no payments were made then why the charges were not covered by the patient’s plan.
- If the EOB indicates a procedure is non-covered or non-allowed, the patient may elect to seek a discount on this uninsured service by making an appointment with the financial counselor.
- If the EOB indicates the charges for a procedure were applied to the deductible and the balance owed is therefore patient’s responsibility, the billing staff shall transfer the balance to the guarantor’s account and the patient is then eligible to apply for a discount through HCI’s Sliding Fee Scale program.
Patients with Health Savings Accounts (HSA’s) are not eligible for Sliding Fee Scale discounts.
Uninsured – For eligibility for the sliding fee discount program, a patient cannot have health insurance of any type. Medicare, Medicaid and ARKids First are forms of health insurance.
Low and moderate income families are eligible for the HCI Sliding Fee Discount Schedule if:
- The family gross income is less than 200% of the federal poverty level as defined by the federal income guidelines and family size.
- Total family assets are less than $10,000. When this figure is calculated, the value of the home, land and one vehicle shall be excluded.
- The financial counselor has on file updated income verification. Clients are required to update their financial status every six months. HCI is required to charge full rates if your financial status is not current.
- Your account is current according to the terms of your payment arrangement. Past due accounts in excess of 90 days will not be eligible for discounts until the account is brought current or special arrangements have been established by your Financial Counselor. If your payment arrangements are not kept as promised, you are temporarily suspended from the sliding fee privilege.
To make an appointment (or get more information) please feel free to call our Mena location at (479) 437-3449 ext 121.