Sliding Fee Scale
Our sliding fee scale is available to patients who have high deductibles, to patients who are uninsured and cannot find affordable health coverage, and to all uninsured patients using Title X Family Planning services.
It is our commitment to make sure everyone in Mount Washington Valley has access to primary care services regardless of financial status. We work hard to follow through on this commitment, by fundraising locally, writing grants, asking for funding from towns and the state, and by keeping our administration lean so that we can focus our resources on patient care.
Our patients can help us in this effort by doing their best to get health coverage now that there are programs available to make it affordable for most people. We offer free, unlimited assistance to help patients understand their options for coverage and enroll in Medicaid or subsidized health insurance.
Patients who are not on the fee scale can receive a 15% discount off of the full cost of service if they pay at checkout.
Sliding fee scale policy
To apply for our sliding fee scale, schedule a meeting with a navigator. The navigator will talk with you about your options for health coverage if you are not covered, and help you fill out a sliding fee scale application.
Bring the following to your appointment:
- Household income documentation, including:
- Your most recent paystub
- Paystubs from your spouse and others in your household
- Documents showing other sources of income, such as rental income, self-employment, social security benefits, and others
- Your most recent taxes
- Any documentation you have for previous Medicaid or Marketplace enrollment
- Information on any insurance offered to you or your spouse by an employer
- The sliding fee scale application with the first part filled in
Your household income and household size determine your fee scale level, which will reduce the cost of services you receive here that are not paid for by insurance. For the exact cost of services at each fee scale level, please see the page on cost of services. Family planning services are exempt and are available at fee scale levels regardless of fee scale application status.
|Sliding fee scale level||1||2||3||4||Family Planning Only||Full Fee|
|Federal Poverty Level (FPL)
click on the link to calculate your FPL
|100% or less||101% - 138%||139% - 168%||169% - 200%||
201% - 250%
251% or more
|Patient fee, percent of total bill
||$10 flat fee*||20%||40%||60%||80%||85%**|
*Except for family planning services, which are free for fee scale 1 patients.
** Only if bill is paid in full at checkout.