Sliding Fee Discount Program
Upstate Family Health Center (UFHC) will offer a Sliding Fee Discount Program to all who are unable to pay for their services. UFHC will base program eligibility on a person’s ability to pay and will not discriminate on the basis of age, gender, race, creed, disability or national origin.
Open the PDF to access the application and bring with you to your appointment.
This program is designed to provide free or discounted care to those who have no means, or limited means, to pay for their medical services. In addition to quality healthcare, patients are entitled to financial counseling by someone who can understand and offer possible solutions for those who cannot pay in full.
All patients seeking healthcare services at UFHC are assured that they will be served regardless of ability to pay. No one is refused service because of lack of financial means to pay.
If you decide to apply, your eligibility is based on two things:
How much income you or your family makes
How many people are 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.
How to Apply
When you make an appointment, we will ask if you have health insurance. If you do not have health coverage, you may apply for the "Sliding Fee Discount Program". The Sliding Fee Discount Program allows patients who have no health insurance or are under-insured to receive healthcare services at a lower cost.
To be part of the program you must provide proof of income for your household. Your income has to be less than the current federal poverty level. The poverty level will depend on the number of people who live in the home and the amount of money they make all together.
The discount for the "Sliding Fee Discount Program" varies but those who qualify and need the most help often can get significant discounts or services.
-Routine preventative exams
-Well child care and immunizations
Fees and How Much You Owe
Those with incomes at or below 100% of poverty will receive a full 100% discount. Those with incomes above 100% of poverty, but at or below 200% of poverty, will be charged according to the attached sliding fee schedule. The sliding fee schedule will be updated during the first quarter of every calendar year with the latest federal poverty guidelines
Nominal Fee: Patients receiving a full discount will be assessed a $10 nominal charge per visit. However, patients will not be denied services due to an inability to pay. The nominal fee is not a threshold for receiving care and thus, is not a minimum fee of co-payment.
UFHC will ensure that no patient with insurance and who is eligible for the Sliding Fee Scale Program will pay more than they would have paid under the Sliding Fee Scale Program alone.
The only exception to this is when the contract between UFHC and the insurance firm requires UFHC to collect the entire amount of copayments and deductibles for services rendered even when UFHC offers a charity care or sliding fee scale program based on income. For example, if a patient with Commercial Blue Cross has a co-payment due on the date of service of $50.00 and that patient is eligible for UFHC Slide A at a nominal fee of $10.00, then the amount due for that patient's visit on the date of service is the nominal fee of $10.00.
Completion of Application
The UFHC patient/responsible party must complete the Sliding Fee Discount Program application in its entirety. By signing the Sliding Fee Discount Program application, persons authorize UFHC access in confirming income as disclosed on the application form. Providing false information on a Sliding Fee Discount Program application will result in all Sliding Fee Discount Program discounts being revoked and the full balance of the account(s) restored and payable immediately.
How Often Do You Need to Reapply?
You will need to apply for this program every year. Your discount will last 12 months. You will need to complete the same application for and provide proof of income.
*Based on 2019 Federal Poverty Guidelines