About the Sliding Fee Scale
As a Federally Qualified Health Center, PHC offers Medical, Dental, Behavioral Health, Pharmacy and lab services on a Sliding Fee Scale. This means that you may be eligible for discounts depending on your household income and family size.
- Sliding fee discounts are available to you even if you have health insurance.
- Sliding Fee Scale Applications must be renewed annually.
Online Sliding Fee Scale Application
To submit a Sliding Fee Scale Application online, please follow two important steps:
1. Fill out the online application here
2. Click here to submit Proof of Income. **IMPORTANT: Please see the section below for approved Proof of Income documentation.
How Does It Work?
When you check in for your appointment we may ask you for a nominal fee. Any balance remaining after insurance payments and the sliding fee scale discount will be billed to you.
Click here to view our 2024 household size & income guidelines for the sliding fee scale. Patients experiencing houselessness or those with Medicaid may have a slide set for their benefit. You will need to submit recent copies of one of the following documents for each earner in your family:
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Most Recent 1040 Tax Form (PHC’s preferred documentation)
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One Month’s Recent, Back-to-Back Pay Stubs or Unemployment Checks (for all employment if working multiple jobs)
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Social Security or Disability Benefit Letter (or most recent bank statement showing monthly deposits)
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Recent bank Statement (for fixed incomes)
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Pension or Retirement Award Letter
Please be aware that we cannot accept W-2’s, 1099s, old taxes, or student loan information.
Questions?
Give us a call at (406) 258-4450.
