Medical Patient Payment Notice

As of July 2016

Payment Notice: Medical Services

CrescentCare is required to collect all copays, deductibles, and sliding fee payments where applicable.

CrescentCare offers a sliding fee discount to patients whose incomes fall at or below 200% of the Federal Poverty Guidelines. Each year the federal government establishes income levels that qualify patients to be eligible to pay reduced costs for services. Sliding fee means that costs change according to the patient’s income, lack of income, or ability to pay. Patients that qualify are eligible for a sliding discount on fees for all services provided at CrescentCare.

If you have insurance, we will charge you according to the guidelines of your insurance plan (for copays and deductibles).   All labs will be billed directly to your insurance plan by the lab company. The lab company will then bill you directly for any outstanding balance. If you do not want to bill your insurance for services we can still see you. You will be considered self-pay and are responsible for your charges, including lab charges. Please ask our staff if you would like to work out a payment plan.

2016 Federal Poverty Guidelines & CrescentCare Sliding Fee Discount for Medical Services

Persons in Household Group A
Family Annual Income: at or below 100% of FPL
Group B
Family Annual Income: 101% up to 125% FPL
Group C Family Annual Income: 126% up to 150% FPL Group D Family Annual Income: 151% up to 200% FPL Group E Family Annual Income: over 200% FPL
1 11,880 14,850 17,820 23,760 23,761 +
2 16,020 20,025 24,030 32,040 32,041 +
3 20,160 25,200 30,240 40,320 40,321 +
4 24,300 30,375 36,450 48,600 48,601 +
5 28,440 35,550 42,660 56,880 56,881 +
6 32,580 40,725 48,870 65,160 65,161 +
7 36,730 45,913 55,095 73,460 73,461 +
8 40,890 51,113 61,335 81,780 81,781 +
For families/households with more than 8 persons, add $4,160 for each additional person.
Approximate Discount 100% 75% 50% 25% 0%
Patient Responsibility Nominal charge ($15) $15 +

See staff for approximate visit amount

$15 + See staff for approximate visit amount $15 + See staff for approximate visit amount $15 + See staff side for approximate visit amount

CrescentCare offers additional assistance for HIV positive patients through the Ryan White Program.

If you are HIV+, please meet with a Case Manager to determine eligibility. Ryan White services apply to individuals at or below 500% of the Federal Poverty Guidelines. The Ryan White program has a separate sliding scale discount.

All of CrescentCare’s sites serve all patients regardless of their ability to pay. Our staff can screen you and help you to enroll in benefits. Please speak with one of our staff for more detailed information.

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