Financial Assistance - Clinic

NOTICE TO PATIENTS

This practice serves all patients regardless of inability to pay. Discounts for essential services are offered depending upon family size and income. You may apply for a discount at the front desk. This practice accepts Medicare, Medicaid, and other insurance plans.

How it works...

Hoxie Medical Clinic offers a Sliding Fee Scale Discount to all eligible uninsured or under-insures patients. This program allows qualifying patients to receive medical care at a lower cost. Eligibility for the Sliding Fee Scale will be established by determining the household size and the annual household income. This info must be updated annually. HMC requires valid proof of income, household size, & completion of a Household Assessment when applying for the sliding scale fee discount.

If a patient chooses not to provide the required information, then he/she will not receive the discounted rate offered through the Sliding Fee Scale Discount Program.

If the patient declares no income, the patient must provide a collaborative letter from the individual assisting the patient financially (who is helping pay your bills, provide housing, etc).

Those who qualify for the sliding scale discount are expected to pay at the time of service. Refusal to pay the appropriate fee may result in the appointment being rescheduled. (some exceptions apply)

Patients with insurance coverage are also eligible to apply for the sliding fee scale. After the insurance has processed the claim & the patient has a remaining balance, then the balance may be adjusted based on the SFS.

Patients who don’t bring proof of income will be allowed to self-declare for the visit. Patient will need to supply income information 14 calendar days from date of service to qualify for Sliding Fee Scale. If completed application & proof of income is not received by the end of the 14 calendar days grace period he/she will be charged the full standard fee.

The necessary documents are listed below. You may drop the completed forms off at the Reception desk.

Federal Poverty Level Guidelines

Interested Party Sliding Fee Letter

Sliding Fee Application

Sponsored Care Application Process

A completed application including the required documentation must be on file and approved by the business office before a discount will be granted. Those requiring assistance with the applicaiton process may contact Sonia Lopez at 785.675.3018.

Download the Sponsored Care Application