Promise Community Health Center has a financial assistance/sliding fee program that applies to our health center services for underinsured, uninsured, and insured patients who meet certain requirements. Promise Community Health Center also has payment plans available. There is no application required to set up a payment plan. Just schedule an appointment with one of our Financial Counselors.
We want to ensure that holistic health care is readily accessible to everyone, no matter their income level, ethnic background, or life situation. Our financial counselors will do everything they can to remove any potential barriers patients may face to receiving the care they need and deserve.
Take these steps to apply for financial assistance/sliding fee program:
1. Contact our clinic to schedule an appointment to see a Financial Counselor.
2. You must provide proof of listed income to complete your application. The following are acceptable forms of income:
- Current Federal Income Tax (1040-1040 EZ Form)
- Paystubs for recent month
- Current bank statement showing direct deposit (SS, SSI, SSD, Fip, Child Support)
- Printout from office issuing payments (SS, SSI, SSD, unemployment, VA, )
- Pension payments, Veteran’s Benefits
- Court order for alimony or child support or printout for child support payments
- Employer statement for cash wages (must include employer name, address and phone number)
- Award Letter
- Letter from caregiver
3. Complete an application with the Financial Counselor.
4. Your application will then be processed at the time of your appointment and communicated to you if you qualify. All information is confidential.
Eligibility is determined by the household size and annual income relative to a discount schedule based on the federal poverty guidelines.
If you need assistance, please contact our office to set up an appointment with one of our certified Financial Counselors. Please call 712-722-1700 or email us at email@example.com.