RCCHC offers eligible patients the following discounts:

• Sliding Fee Discounts based on annual household income
• Prompt Pay Discount of 20% for all patients that pay their charges in full on the day of service
• Payment Plans are available if not disqualified previously

RCCHC must provide access to services without regard for a person's ability to pay; the ability to pay is determined by a patient's annual income and family size according to the most recent U.S. Department of Health & Human Services Federal Poverty Guidelines.

Explanation of the Sliding Fee Discount Program

The Sliding Fee Discount Program is a federal program that permits Roanoke Chowan Community Health Center to discount normal charge for either a medical or dental visit. According to law, it requires two pieces of information in order to qualify: the amount of income in the household and the number of people who live in the household. In order to be eligible for the Sliding Fee Scale, you must provide accurate and acceptable proof of income as well as list all persons in the household. These forms of documentation must be presented upon applying for the Sliding Fee Discount Program. Failure to provide such documentation in a timely manner will cause a delay in processing your application and you will be responsible for 100% of all charges including any lab work performed. You must report any changes in family income or number of member in the household when these changes occur. Falsification of this information will result in forfeiture of the Sliding Fee Scale privileges and possible release from the practice as it is a violation of Federal Law.

Eligibility

All RCCHC patients are eligible to apply for the slide. Determination of the discount, if any, is dependent upon household income and household size in comparison to the current Federal Poverty Guidelines. This discount may apply to insurance / Medicare copays and Medicaid Family Planning non-covered services.

Term

Information must be updated every twelve (12) months or with any change of household income or household size. Definitions and Examples of Acceptable Proof Required

Income Determination

• Income is based on the gross income of all household members earning income. Income used to compute poverty status:
  • Includes earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Income, public assistance, veterans’ payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties’, income from estates, trust, educational assistance, alimony, child support, assistance from outside the household and other miscellaneous sources.
• Acceptable forms of proof for determining income include the following:
  • Income tax return: A signed copy of the most recent tax return showing Adjusted Gross Income.
  • Pay check stubs: Two or more consecutive pay stubs indicating gross pay within the past thirty (30) days.
  • Agency letter: A letter from the Social Security Administration, Veterans Administration, or Social Service Agency (i.e., FNS, food stamps)
  • Unemployment Verification: Paperwork from the Employment Securities Commission (ESC) proving unemployment status and the amount of compensation being received.
  • Court Documents: Official documents citing child support or alimony an awarded by a judge.
  • Official Paperwork: Paperwork documenting retirement, disability, SSI benefits.
  • Employer Letter: For those not receiving an actual paycheck, a letter from the patient’s employer detailing current gross income and frequency of pay period may be accepted. Contact information must be provided so that information can be verified.

Household size Determination

• All members of a household who are pooling financial resources including room and board and/or are supporting one another financially are counted as one household.
• Household size can be documented with any of the following:
  • A copy of the most recent tax return showing household size.
• Social Security Card
• Birth Certificate
• Medicaid cards for any dependent children
• Driver’s License or State ID’s

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