Sliding Fee Scale

The Sliding Fee Scale (SFS) is for those who do not have medical and/or dental insurance or those with high deductible/sliding fee amount and non-covered services. It is based upon income and the number of dependents in the household. Those that are uninsured and homeless are seen for FREE.

To receive follow up visit discounts, patients must qualify for the SFS, be seen within two weeks, have the same diagnosis, and have paid for the prior visit. The sliding fee schedule shows the discounts allowed for ECHO patients who meet the criteria for income level; if your income status changes, it could benefit you; bring your new income information in.

CRITERIA: You must provide PROOF of income each year or as changes occur in your income; otherwise your visit will be full price.

Locate your household income on the chart below, then find your sliding fee amount.

Federal Poverty Guidelines

For Households with more than 8 people, add $5,140 for each additional person.

Patients at 100% or below with an income in the chart below by the number of people in your household will receive the maximum discount and your visit charges will be the nominal fee of $22.

Patients with an income above 100% will receive a discount if allowed by income and number of people in your household. Please see Sliding C though Sliding F listed below. All others above 200% will be charged $100 up front and billed the remainder.

Sliding Fee Amounts

Follow-up visit is for visit within 14 days for the same issue.

Homeless
$0
Amount per visit
$0
Follow up visit
N/A
% Of Fed Poverty Guideline
Sliding B
$22
Amount per visit
$6
Follow up visit
0-100
% Of Fed Poverty Guideline
Sliding C
$34
Amount per visit
$9
Follow up visit
101-125
% Of Fed Poverty Guideline
Sliding D
$40
Amount per visit
$13
Follow up visit
126-150
% Of Fed Poverty Guideline
Sliding E
$50
Amount per visit
$17
Follow up visit
151-175
% Of Fed Poverty Guideline
Sliding F
$60
Amount per visit
$22
Follow up visit
176-200
% Of Fed Poverty Guideline

ECHO Community Health Care, Inc. is a participating entity in the federal 340-B drug pricing program. Please be informed that you have the right to choose the pharmacist and pharmacy provider where your prescriptions are filled and to not be pressured or coerced into transferring your prescriptions to another pharmacy or mail-order service.

 

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.

 

Under federal law, patients who don’t have insurance or who are not using insurance are entitled to receive a good faith estimate (GFE) of the expected charges for medical items and services.

You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services you receive at ECHO Community Health Care (ECHC). This includes related costs like medical tests, clinic-administered prescription drugs, equipment, and related services performed during visits.

You have the right to receive a Good Faith Estimate in writing prior to your scheduled appointment. If you schedule an appointment more than 10 business days in advance, or request a GFE without scheduling an appointment, ECHC has 3 business days to provide it.

If you schedule an appointment between 3 and 9 business days in advance, ECHC has 1 business day to provide the GFE.

If you are uninsured or not using your insurance to pay for your health care services and receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call No Surprises Help Desk at 1-800-985-3059.