Discounted Medical & Dental Care
PURPOSE
To ensure no patient will be denied quality health care services due to an individual’s inability to pay, Healthy Connections, Inc. (HCI), has established a system for discounting medical, behavioral health, radiology, lab, and dental care for eligible families.
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 your case’s determination, you may file an appeal.
PRIVILEGES
- Discounted medical, behavioral health, radiology, lab, and dental care is based on your household’s gross income and the number of persons living in a domicile to help uninsured and underinsured patients. The guidelines are established by the Healthy Connections, Inc. Board of Directors annually.
- You may have your discount category recalculated at any time your family gross income or household size changes.
- 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.
RESPONSIBILITIES
- After initial qualification for sliding fee discounts, you must requalify every 12 months by presenting proof of income and verification of household size to the Financial Counselor or Patient Care Coordinator at any Heathy Connections clinic.
- 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.
- 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.
SLIDING FEE DISCOUNT SCHEDULES SHALL
- Apply to patients with annual incomes at or below 200% of the Federal Poverty Level (FPL).
- Provide a full discount for patients with annual incomes at or below 100% FPL with an allowance for a nominal charge.
- Adjust fees based on household size and income for patients above 100% FPL and at or below 200% FPL.
- Include at least three discount levels between 100% FPL and 200% FPL.
- Discount does not apply to patients with annual incomes above 200% FPL.
DEFINITIONS
Household -Defined to mimic the state and federal household definition for healthcare programs and outlined in the Sliding Fee Scale Verification Policy. The Financial Counselor with follow guidelines outlined within HCI’s Sliding Scale Operations Procedure Manual.
Gross Household Income– The modified adjusted gross income (MAGI) as defined by the IRS and used by the state and federal agencies’ healthcare programs. Income refers to all cash receipts before taxes with certain adjustments. Income does not include non-cash benefits such as SNAP, school lunch programs, clothing vouchers, or food/rent in lieu of wages. For most patients eligible for sliding fee discounts, income calculation is simple. A full definition of MAGI is available from the IRS.
Dental Discounts– Preapproved full-price charges may be reduced to the current basic office fee depending upon the patient’s sliding fee category. See HCI’s sliding fee discount scale.
Medical & Behavior Health Discounts– Full-price charges may be reduced to the current basic office fee depending on the patient’s sliding fee discount category. See HCI’s sliding fee discount scale.
Lab Discounts– Full price charges may be reduced depending on the patient’s sliding fee discount category and depending on the day lab work is completed. See HCI’s sliding fee discount scale.
X-Ray & Ultrasound Discounts– Full price charges may be reduced depending on the patient’s sliding fee discount category. See HCI’s sliding fee discount scale.
No Income Statements– An individual or household with “zero income” must sign a “No Income Statement.” This is a legally binding document.
Proof of Income– This must be current information that includes, but is not limited to, personal tax return or W-2, pay stubs, signed letter from employer, unemployment checks, awards letter, bank statement (for Social Security benefits only.) Self-employed patients are required to provide tax returns, and bank statements are not required or allowed. Where proof of before-tax income is not available, income before taxes can be estimated from proof of net income. Verbal estimates are NOT acceptable.
ELIGIBILITY
Low and moderate-income families are eligible for the HCI Sliding Fee Discount Schedule if:
- The household gross income is less than 200% of the federal poverty level as defined by the federal income guidelines and family size.
- The financial counselor has on file updated income verification. Clients are required to update their financial status every twelve 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 may be temporarily suspended from the sliding fee privilege.
To make an appointment (or get more information) please feel free to call (479) 437-3449, extension 121.