Sliding Fee Scales
As a Federally Qualified Health Center Look-Alike, Equitas Health offers discounted services to patients who are uninsured and/or meet the below income thresholds. We also provide discounted mental health counseling for patients with low income who have medical insurance that does not cover mental health counseling. The amount a patient pays is based on the federal poverty levels, income, and number of dependents. Each year the federal government sets a Federal Poverty Line (FPL) and new income levels that qualify patients for discounted care. The income levels are based on a patient’s gross income (how much money you make each year before taxes are taken out).
Special Charges for Patients with HIV/AIDS
The Ryan White Program is a federal grant that helps Equitas Health cover some health care costs for patients with HIV/AIDS. Patients living with HIV/AIDS are eligible for the Ryan White Sliding Fee Scale based on their annual gross income. The Ryan White Sliding Fee Scale is almost identical to Equitas Health’s Sliding Fee Scale for HIV negative patients. With two exceptions, patients with HIV/AIDS at or below 100% of the FPL are not charged for any service they receive at Equitas Health, all other patients who are HIV negative under 100% FPL will be charged a nominal fee. The other exception is the Ryan White scale goes up to 300% FPL, and the Equitas Health scale goes up to 200% FPL. In addition, if any patient has insurance, we must use it, before any discount or Ryan White grant funds can be used.
How do I qualify?
To qualify for the Equitas Health Sliding Fee Scale or Ryan White Sliding Fee Scale, you must bring proof of your “household” gross annual income. A “household” includes legal children, a civil union partner or married spouse, and legal dependents. Annual gross income includes salary, unemployment benefits, disability or social security benefits, investment income or other sources of income that support the household. You should bring proof of all of the household income for yourself and everyone in your household. Applicants must provide one of the following: prior year W-2, two most recent pay stubs, letter from employer, or Form 4506-T (if W-2 not filed). Self-employed individuals will be required to submit detail of the most recent three months of income and expenses for the business. Adequate information must be made available to determine eligibility for the program. Self-declaration of Income may only be used in special circumstances. Specific examples include participants who are homeless. Patients who are unable to provide written verification must provide a signed statement of income, and why (she/he) is unable to provide independent verification. This statement will be presented to Equitas Health’s Director of Healthcare Revenue or his/her designee for review and final determination as to the sliding fee percentage. Self-declared patients will be responsible for 100% of their charges until management determines the appropriate category.
How do I apply?
To qualify, complete the Equitas Health Sliding Fee Application 2017 and bring it with you to your next appointment or ask for a copy of the application at the registration desk of any Equitas Health clinic locations. A financial counselor will guide you through the process and determine your eligibility. If you have questions about the Sliding Fee Scale, please contact the registration desk of your clinic location:
- Equitas Health – Dayton: (937) 853-3650
- Equitas Health – King-Lincoln: (614) 340-6700
- Equitas Health – Short North: (614) 340-6777.