Sliding Fee Schedule Program

Image

At Southwest Georgia Healthcare Clinics, we are committed to providing quality healthcare to the patients we serve regardless of their ability to pay.

Any patient may apply for the fee adjustments based on their income and the size of their family.

The sliding fee scale cannot be used for charges payable to Medicare, Medicaid, private insurance or any third party payers. However, the sliding fee schedule adjustments may pay for services not covered by insurance carriers.

To apply for this service, each patient is required to complete an Application.

Application
Spanish Application

Program Requirements

  • All verification information must be from patient or head of household.
  • Submit one month of the most recent payroll check stub; or statement from current employer; or proof of any other income received (child support, SSI, alimony, etc.); W-2 forms are accepted
  • Submit three (3) letters from non-related persons verifying that patient is not employed. If proof of income is not submitted in person within 30 days of initial application, the patient may be removed from the Sliding Fee Schedule Program.
  • The Sliding Fee Schedule Program application must be renewed annually. Changes in family income must be reported to the Sliding Fee Schedule Program clerk or receptionist.

Nurturing Health.

Connecting Community.
Learn More