Sliding Fee Policy

WEISBROD HEALTH – FISCAL SERVICES

Sliding Fee Scale

Scope – District Wide

Policy: 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 (Uninsured or Underinsured). Weisbrod Health will offer a Sliding Fee Scale to all who are unable to pay for their services. Weisbrod Health will not base program eligibility on a person’s ability to pay and will not discriminate on the basis of an individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity. The Federal Poverty Guidelines are used in creating and annually updating the sliding fee schedule to determine eligibility.

Completion of Application: The patient/responsible party must complete the Sliding Fee Scale Approval Form in its entirety. By signing the form, persons authorize KCHD access in confirming income as disclosed on the application form. Providing false information on a Sliding Fee Scale Approval Form will result in all Sliding Fee Discounts being revoked and the full balance of the account(s) restored and payable immediately.

Eligibility: Discounts will be based on income and family size only. KCHD uses the Census Bureau definitions of each.

1. Family is defined as: a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family.
2. Income includes: earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources. Noncash benefits (such as food stamps and housing subsidies) do not count.

Income Verification: Applicants must provide one of the following: Last year’s income tax return, prior year W2, two most recent pay stubs, letter from employer, or Form 4506-T (if W-2 not filed). Adequate information must be made available to determine eligibility for the program.

Discounts: Those with incomes at or below 100% of poverty will receive a full 100% discount with a nominal fee. 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 should be made aware that there are minimums which will be required from them such as clinic visits $10.00 and $10.00 for hospital/emergency room visits, even if they qualify for the maximum discount possible. However, patients will not be denied services due to an inability to pay. All KCHD collection rules shall apply. In certain situations, patients may not be able to pay the minimum fee. Waiving of charges may only be used in special circumstances and must be approved by the CEO, CFO, or their designee.

Notification: The CFO will determine if the patient qualifies and will notify the patient and clinic and hospital. At this time a detailed charge list will be generated with all the charges. This information will be gone over with the patient, so they have a clear understanding of what they owe. If they are not able to pay, a payment plan should be set up. This payment plan should be no less than $10.00 per month.