Sliding Fee Information

Promise Community Health Center ensures that no one will be denied access to health services due to their inability to pay.

Our sliding-fee program allows us to reduce or "slide" the fees for the care of you or your family. You can apply for the program if you need assistance to help you pay for your care.

Eligibility is based on family income and family size. Your bill always will be at least $25 for medical services; $40 for dental, vision and behavioral health services; and $15 for lab services. This minimum amount is due at the time of your visit, as well as payment for any other unpaid balances.

To apply for the sliding fee, please provide your most recent pay stubs for the last 30 days, current personal income tax return or an unemployment benefit statement.

You can download the Sliding-Fee Application here:

English version

Spanish version

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SLIDING-FEE SCALE - Based on 2019 Federal Poverty Guidelines

*If actual charges are less than amounts shown, patient pays lesser amount.

 

Federal Poverty Level

<100% FPL

101-133% FPL

134-166% FPL

167-199% FPL

>200% FPL

Slide Level

A

B

C

D

E

Medical Sliding Fee

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Patient Pays*

$25

$50

$75

$100

100% of charges

Dental Sliding Fee

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---

---

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Patient Pays*

$40

Greater of 25% or $40

Greater of 50% or $40

Greater of  75% or $40

100% of charges

Vision Sliding Fee

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---

---

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Patient Pays*

$40

$60

$70

$80

100% of charges

Behavioral Health Sliding Fee

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---

---

---

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Patient Pays*

$40

$60

$80

$120

100% of charges

Lab Visit Sliding Fee

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---

---

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Patient Pays*

$0

$0

$0

$0

100% of charge

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Note: Promise's family planning services operate under a separate sliding-fee scale. For more information, visit the family planning page.

 

2019 FEDERAL POVERTY GUIDELINES

MONTHLY INCOME

Number in Household

A

B

C

D

E

1

$0-$1,041

$1,042-$1,388

$1,389-$1,735

$1,736-$2,082

>$2,083

2

$0-$1,409

$1,410-$1,879

$1,880-$2,349

$2,350-$2,818

>$2,819

3

$0-$1,778

$1,779-$2,370

$2,371-$2,963

$2,964-$3,555

>$3,556

4

$0-$2,146

$2,147-$2,861

$2,862-$3,576

$3,577-$4,292

>$4,293

5

$0-$2,514

$2,515-$3,352

$3,353-$4,190

$4,191-$5,028

>$5,029

6

$0-$2,883

$2,884-$3,843

$3,844-$4,804

$4,805-$5,765

>$5,766

7

$0-$3,251

$3,252-$4,334

$4,335-$5,418

$5,419-$6,502

>$6,503

8

$0-$3,619

$3,620-$4,826

$4,827-$6,032

$6,033-$7,238

>$7,239

9

$0-$3,988

$3,989-$5,317

$5,318-$6,646

$6,647-$7,975

>$7,976

10

$0-$4,356

$4,357-$5,808

$5,809-$7,260

$7,261-$8,712

>$8,713

11

$0-$4,724

$4,725-$6,299

$6,300-$7,874

$7,875-$9,448

>$9,449

12

$0-$5,093

$5,094-$6,790

$6,791-$8,488

$8,489-$10,185

>$10,186

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ANNUAL INCOME

Number in Household

A

B

C

D

E

1

$0-$12,490

$12,491-$16,653

$16,654-$20,817

$20,818-$24,980

>$24,981

2

$0-$16,910

$16,911-$22,547

$22,548-$28,183

$28,184-$33,820

>$33,821

3

$0-$21,330

$21,331-$28,440

$28,441-$35,550

$35,551-$42,660

>$42,661

4

$0-$25,750

$25,751-$34,333

$34,334-$42,917

$42,918-$51,500

>$51,501

5

$0-$30,170

$30,171-$40,227

$40,228-$50,283

$50,284-$60,340

>$60,341

6

$0-$34,590

$34,591-$46,120

$46,121-$57,650

$57,651-$69,180

>$69,181

7

$0-$39,010

$39,011-$52,013

$52,014-$65,017

$65,018-$78,020

>$78,021

8

$0-$43,430

$43,431-$57,907

$57,908-$72,383

$72,384-$86,860

>$86,861

9

$0-$47,850

$47,851-$63,800

$63,801-$79,750

$79,751-$95,700

>$95,701

10

$0-$52,270

$52,271-$69,693

$69,694-$87,117

$87,118-$104,540

>$104,541

11

$0-$56,690

$56,691-$75,587

$75,588-$94,483

$94,484-$113,380

>$113,381

12

$0-$61,110

 $61,111-$81,480 

$81,481-$101,850

$101,851-$122,220

>$122,221