This is our Promise: Affordable healthcare for all members of our community.
All patients are eligible to apply for Promise’s sliding fee scale discount program. Eligibility is based on family size and income. Patients that are approved for the sliding fee discount scale are eligible for discounted services. Talk with our financial counselors to find which of our payment options works best.
What is the sliding fee discount scale?
The sliding fee discount scale is a tool that determines how much patients are responsible for after receiving medical/dental care. The sliding fee scale is based on family size and income. In order to qualify for our sliding fee scale, the patient will need to complete an application at the time of the visit and provide proof of income within 30 days. No patient will be refused services based on their ability to pay.
What is the sliding fee discount based on?
The sliding fee discount scale is based on family size and income. For more information please view the Federal Poverty Guidelines.
If I have insurance do I still qualify for the sliding fee discount?
Yes – You will need to complete an application at the time of the visit and provide proof of income within 30 days.
When is the nominal fee due?
A Nominal fee – is a fixed charge or fixed percent of cost of service and does not reflect the true value of the service provided. This nominal fee is due at the time of your visit. The nominal fee will be for the office visit only. Additional charges may apply for supplies, labs, x-ray, and dental surgery/rehabilitation services.
Promise Community Health Center has Financial Counselors available to help review your eligibility for the sliding fee discount. They can also help review your health insurance options and get enrolled. To make an outreach assistance appointment, please call 712-722-1700.
You have the right to a “Good Faith Estimate” explaining how much your care will cost
Under the law, health care providers need to give patients who are uninsured or self-pay or who are not using insurance an estimate of the bill for items and services provided by Promise Community Health Center.
• You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services.
• Good Faith Estimate will be provided to you in writing before your service or item if scheduled 3-10 business days in advance. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• Promise Community Health Care, as part of the course of care, may recommend additional services that will need to be scheduled or requested separately and are not reflected in the GFE.
• The GFE is only an estimate of items or services reasonably expected to be furnished at the time it was issued, and that actual items, services, or charges may differ from the GFE.
• The GFE is not a contract and does not require the uninsured (or self-pay) individual to obtain the items or services from Promise Community Health Center or any other provider listed.
• The patient may initiate the patient-provider dispute resolution process if the actual billed charges are substantially in excess of $400.00.
Promise Community Health Center accepts cash, check, credit card, most forms of insurance, Medicare, and Medicaid.
For your convenience, you can also pay your bills online. It may be helpful to have your billing statement in front of you, as it will have necessary information. Payments will be processed within three business days.
Dental online bill pay is not available. You can pay by cash, check, or credit card. Please call 712-722-1700 with any questions on your bill.
Cash and check payments may be sent in the mail to the address listed below or you can click the button and pay online.
33 4th St NW,
Sioux Center, IA 51250