| Fees |
| Medicaid,
Medicare and commercial insurance
are welcomed. A financial assistance program is available, based
on income and eligibility.
Discount Policy:
Daughters of Charity Health Centers maintain a system in place to
determine eligibility for patient discounts based on the patient’s
household assessment determined by family income and family size.
Payment Policy: Daughters
of Charity Health Centers collect all applicable payments, co-payments,
and/or deductibles at time of service.
|
|
| Patient Billing Policy
|
| Proof of income
is required at time of service to determine eligibility for a discount
based on the following Federal Poverty Guidelines:
| Family
Size |
Household
Income |
| 1 |
$10,830 |
| 2 |
$14,570 |
| 3 |
$18,310 |
| 4 |
$22,050 |
| 5 |
$25,790 |
| 6 |
$29,530 |
| 7 |
$33,270 |
| 8 |
$37,010 |
|
For families with more than 8 persons, add
$3,740 for each additional member. SOURCE: Federal Register,
Vol. 74, No. 14, January 23, 2009, pp. 4199–4201
|
Household
Assessment
Patient
Discount Eligibility Form |
We provide discounts to uninsured patients
based on family size and household income. Therefore, in order
to make your visit to our Health Center as pleasant as possible
for you and your family, please bring the following documents
with you to your visit:
a. Driver’s license or photo ID
b. Insurance card, if applicable
c. Proof of income (pay stub, Social Security, etc)
We also ask that you arrive 30 minutes
early for your first appointment and that you bring all medications
with you. Please know that payment is due at time of service.
|
| |
| Patient
Billing Policy |
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|
