Challis Area Health Center, Inc., Sliding Discount Program
Rules, Guidelines, and Limitations
FREQUENTLY ASKED QUESTIONS:
What is the Sliding Fee Discount and how do I qualify?
It is the policy of Challis Area Health Center, Inc. (CAHC, Inc), to provide essential services regardless a patient’s inability to pay. Discounts are offered on a sliding discount that is based off of the Poverty Level that is published by Health and Human Services each year for patients who meet the income requirements. The patient’s household size and annual income is used to determine which level of discount they qualify for. If the household income is above 200% of poverty, we are not allowed to provide any discount. If the patient is insured but meets the income requirements for a discount, CAHC, Inc. will submit all charges to the insurance carrier first and then any patient balance will be eligible for the sliding fee program. The insured patient is still required to pay their co-pay at time of service; if the patients insurance has a co-payment due the Patient will pay the sliding fee co-pay at time of service instead.
If you feel you may qualify and/or are interested in applying for the program you will need to complete a Application and Financial Application for the program and return it to CAHC, Inc, along with copies of ALL documentation required to verify your eligibility for the sliding discount. This can be picked up in person or we can mail it to you. You can mail it back to the clinic at the PO Box listed above, with copies of ALL required documentation, or you can return it to the clinic and we can make copies and determine your enrollment at that time.
If you wish to apply the sliding discount to your current office visit, you will need to return the completed application and submit your documentation within 5 WORKING DAYS of the date of the visit.
What is covered?
The discounts under the sliding discount program for Challis CAHC, Inc., apply to office visits, exams, physicals, procedures and services performed by OUR PROVIDERS. Labs and x-rays that are ordered by OUR PROVIDERS are also covered under the sliding discount.
What is NOT covered?
Labs and x-rays ordered by OUTSIDE PROVIDERS/FACILITIES (any person(s), clinic, hospital, etc.) are NOT COVERED under the sliding discount and are billed at regular cost. When we take x-rays, they have to be interpreted by a radiologist. The amount the radiologist charges for interpreting the x-ray is not covered by the sliding discount, you will be billed separately by the radiologist. This bill will not come from our office. The Ambulance/EMT, Life Flight, and related services ARE NOT COVERED under the program. You will receive a separate bill from them. Referrals to other providers, clinics, specialists, hospitals, imaging, etc. are not covered under the Sliding Discount Program.
How long is my application approved for and when do I need to re-apply?
Upon approval, your current enrollment ends on April 30th of each year. Your discount will NOT be valid after this date. After your initial enrollment into the program your application will be valid for the current year, this runs from May 1st to April 30th each year. You will be notified by mail at least 30 days prior to your enrollment ending.
**If you enroll prior to that deadline you will need to provide updated tax/income info in April of that year**
You will need to provide new updated income or tax documents in April of each year for re-evaluation. An application will be mailed to you, you can fill this out at home and mail back the application with copies of ALL required documentation or you can complete the application at the clinic and bring all the required documentation with you. You will be notified by mail regarding the approval or denial of your application. You will need to come into the clinic to complete your enrollment and review the Program Rules, Guidelines, Limitations and Patient Agreement with a member of our Staff.
What do I need to apply?
When applying identification (Drivers License, State ID, Military ID are acceptable), dates of birth, address, phone number, employment status, social security numbers (a copy of the SSN card is required) for each person(s) living in the household. For children or dependents under 18 a copy of social security card or birth certificate is required. You will need to provide proof of income for the household and each person in the household. This includes a copy of your last year’s income tax return or copies of the last 3 months paycheck stubs/payroll showing year-to-date earnings are required. Copies of all money coming into the household needs to be provided, this includes wages/salary, food stamps, child support, alimony, disability, SSI, worker’s compensation, self-employment, unemployment, spouse income, assistance from family members or friends, etc.
If you have not had any income for 3 months or more, this must be verified through some other official agency record, i.e., bank statements or by a written statement from a landlord or other person outside the household having knowledge of the patients financial situation.
If you fail to provide sufficient documentation or to re-apply, you will be disenrolled from the sliding discount program.
What is the Co-Pay amount I will have to pay and why do I have to pay it?
Your eligibility for the program is based on your income and household size, using the HHS Poverty Level we will determine how much of a discount and what co-pay plan you qualify for. The Co-Pay amounts range from $25 to $65 with associated discounts of 100% - 80% depending on your eligibility. You are required to pay the co-pay amount at the time of service, prior to check-in for your appointment in order to receive the sliding discount for that appointment. You are not allowed to make your co-pay the next day, week, or month. If it is not paid at the time of service, the visit will be billed out at FULL price. It is your responsibility to have your co-pay ready at the time of your appointment. You are required to pay a minimum co-pay amount for the services you receive in order to receive the Discount on your care.
If you pay with a check and that check is returned, your visit WILL NOT be discounted for that date and you will owe a $25 returned check charge for each check returned.
If you qualify, the 20% - 80% Discount (see the table) will be taken off the total cost of your appointment after your Co-Pay is deducted. I.e. If your visit is $100 and you have a $35 Co-Pay with a 80% Discount, you would take $100-$35 = $65. You would then take the remaining $65 and deduct 80% from that leaving a total remaining cost of $13 that you would owe for your visit.
What is the Poverty Level?
The poverty guidelines are issued each year in the Federal Register by the Department of Health and Human Services (HHS). These guidelines are used to determine financial eligibility for specific programs including the sliding fee discount program offered at CAHC, Inc. Whichever plan a patient qualifies for is based on their household size and their total annual income. See the graph below:
*** See below for the 2017 Poverty Level Chart ***
I’m interested, how do I get the application or information?
To request information regarding the discount program call our office at 208.879.4351 Ext. 2. Our Enrollment Specialist, Sara Jones and our Customer Service Representative, Jessie Smithers can both assist you with program questions and the enrollment process. You can enroll in this program at any time; you do not have to wait until you are seen at the clinic for an appointment.
By enrolling prior to an appointment you will be covered when you need it!
2017 Poverty Level Guidelines
Household Size < 100% 101%-125% 126%-150% 151%-175% 176%-200% 200% >
1 $0-$12,060 $12,061-$15,075 $15,076-$18,090 $18,091-$21,105 $21,106-$24,120 $24,121+
2 $0-$16,240 $16,241-$20,300 $20,301-$24,360 $24,361-$28,420 $28,421-$32,480 $32,481+
3 $0-$20,420 $20,421-$25,525 $25,526-$30,630 $30,631-$35,735 $35,736-$40,840 $40,841+
4 $0-$24,600 $24,600-$30,750 $30,751-$36,900 $36,901-$43,050 $43,051-$49,200 $49,201+
5 $0-$28,780 $28,781-$35,975 $35,976-$43,170 $43,171-$50,365 $50,366-$57,560 $57,561+
6 $0-$32,960 $32,961-$41,200 $41,201-$49,440 $49,441-$57,680 $57,681-$65,920 $65,921+
7 $0-37,140 $37,141-$46,425 $46,426-$55,710 $55,711-$64,995 $64,996-$74,280 $74,281+
8 $0-41,320 $41,321-$51,650 $51,651-$61,980 $61,981-$72,310 $72,311-$82,640 $82,641+
9 $0-$45,500 $45,501-$56,875 $56,876-$68,250 $68,251-$79,625 $79,626-$91,000 $91,101+
Plan #: Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Not Eligible
Reduction %: 100% 80% 60% 40% 20% 0%
Minimum Co-Pay: $25.00 $35.00 $45.00 $55.00 $65.00 Full Price
If your income falls between the incomes per household, you may be eligible for the Sliding Scale Program. Please contact the Challis Area Health Center at 208-879-4351 ext. 2 to make an appointment with our Enrollment Specialist.
Sliding Fee Service
The Challis Area Health Center, Inc provides essential health services regardless of the patient’s ability to pay.