Frequently Asked Questions
What is the Sliding Fee Scale?
The Sliding Fee Scale is a Federal program that allows NorthLakes Community Clinic to discount our normal charges for health care services rendered at our locations. The Sliding Fee Scale Discount Program is available to all qualifying patients regardless of insurance status. NorthLakes Community Clinic will never deny healthcare based on the patients inability to pay.
This program works in part, in accordance with the Federal Poverty Guidelines- http://aspe.hhs.gov/poverty
Who can apply for the Sliding Fee Scale?
Anyone is welcome to apply for the Sliding Fee Scale.
How is eligibility for the Sliding Fee Scale determined?
Eligibility is determined on the household size, annual gross income (net income for self-employment) for the household, completed application, and proof of income.
How do I get an application for this program?
Ask for a Sliding Fee Scale packet at our Front Desk staff. Resource Coordinators are available to answer questions or help filling out the Sliding Fee Scale Application.
What type of documents do I need to bring to apply for Sliding Fee Scale?
You will need to bring in proof of income for all the household members over age 19 and a completed Sliding Fee Application.
What can be used as Proof of Income?
Accepted documents for proof of income:
- Most current 1040 tax form (preferred)
- 3 months of most recent pay stubs
- Award letters from Social Security or Pensions, Annuities, Trust funds
- Orders for received Child Support or Alimony
- 3 months of most current Unemployment statements or check stubs
If you cannot provide any of the above, please include:
- Payroll & Earnings Verification Statement (Available at the Front Desk)
- Last 3 months bank statements showing income deposits
If you have no income:
- Self-Declaration of No Income Form (Available at the Front Desk)
What if the Proof of Income I can provide is not on the list?
You can contact a Resource Coordinator to help.
Who is considered a “household member”?
Household members are related by blood, marriage or adoption, and financially responsible to each other. Roommates do not qualify as ‘Household member’.
When is my Sliding Fee Scale effective?
The sliding fee scale discount, if you qualify, will backdate 14 days from the day which you are given the application.
When does my Sliding Fee Scale expire?
The Sliding Fee Scale discount will expire at the end of month, 1 year from approval date.
You must re-apply prior to the expiration date in order to continue being covered under the Sliding Fee Scale Program. Failure to do so may result in the patient being responsible for the full amount of any charges incurred during the lapse.
How often do I need to apply for this program?
You must apply every year. You may re-apply up to four times a year if there is a change in your current household size or income.
I do not want to provide my financial information. Am I still eligible for the Sliding Fee Scale?
Eligibility for the Sliding Fee Scale is based on your income and household size. If you choose not to provide NorthLakes Community Clinic with this information you will be responsible for the total charges for services received.
Are my medications covered under this program?
Patients without any health insurance who have been approved for the Sliding Fee Scale may be able to receive a subsidy for prescription drugs through NorthLakes Community Clinic’s pharmacy or prescription program.
What services does the Sliding Fee Scale cover?
The sliding fee scale applies only to those services provided directly by or controlled by NorthLakes Community Clinic. Services provided under referral are not covered by NorthLakes Community Clinic sliding fee. Some examples are: Medical visits, Behavioral Health visits, and Physical and Occupational Therapy.
How much will I pay if I am approved for the program?
The charge for your visit depends on your income, household size, and the type of service you received. When you are approved for the Sliding Fee Scale you will receive a card that details your financial responsibility for services received. Payments are due at the time of service. If you have private insurance, your normal co-pays still applies.
Who should I contact if I have more questions?
Our Resource Coordinators can help you. Call 888-834-4551.
Resource Coordinators are available at these NorthLakes’ Clinics: