POLICY: All patients seen by any PATHS’ health care delivery site are advised of their right to apply for sliding fee status based on net household income and family size. Patients are registered at 100% self-pay status until they apply for sliding fee status. All pay statuses will be reviewed and updated annually, or as needed. PATHS reserves the right to initiate a random pay status review when there is reason to suspect that the income and/or family size provided by the patient is inaccurate, incomplete, or in any way untrue. After a thorough investigation, lead by the Chief Operating Officer (or designee), the pay status of a family, whose responsible party has given false information, will be raised to 100% self pay. The pay status of any family who refuses to cooperate with a review, whether annual or otherwise, will be raised to 100% self pay.
1. Signage will be clearly posted in the dental waiting room announcing the availability of special payment options for those who qualify, and all front desk staff members will be trained to explain that all patients are assigned to 100% self pay status unless the patient applies for sliding scale.
2. It will be explained to the patients who wish to apply for sliding fee status that they must furnish the number of individuals in the family, and the whole family’s gross annual income from all sources, i.e., rent on property owned, interest from savings, investments, etc.
3. All sliding scale applicants must provide proof of income in order to receive sliding scale benefits, such as:
a. W-2 forms from the previous year’s tax return;
b. Copies of recent pay checks/stubs;
c. Copy of welfare checks; and/or
d. Copy of previous year’s tax return.
4. All information will be scanned into the patient’s medical record, and entered into PATHS’ Dental EHR system, which will automatically determine and assign the appropriate sliding fee status.
5. Determining Eligibility: Eligibility will be determined based on the patient’s household income. The definition of household will follow the standard set by legal responsibility. For example, a married couple with three minor-aged children will be considered a household of 5. An unmarried adult (over the age of 18) that lives with someone else (friends or family) with no children/dependants, will be considered a household of 1. Income will be determined based on the total net income of each member of the household, and will be compared to the most recent federal poverty limits. Patients up to 100% of the federal poverty limit will be considered eligible for benefits under PATHS’ Dental Center’s Slide A program. Patients between 101% and 200% of the federal poverty limit will be considered eligible for PATHS’ Dental Center’s Slide B program.
6. Slide A: Patients found to be eligible for “Slide A” will receive a 100% discount for all basic, general dentistry services (listed in Appendix A). These patients will be charged a nominal fee of $50 per visit, regardless of the combination of procedures that will be provided. Each visit will be scheduled to consume no more than one (1) hour.
7. Slide B: Patients found to be eligible for “Slide B” will receive a 100% discount for all basic, general dentistry services (listed in Appendix A). These patients will be charged a nominal fee of $75 per visit, regardless of the combination of procedures that will be provided. Each visit will be scheduled to consume no more than one (1) hour.
8. Patients with insurance are eligible to apply for sliding scale benefits. Any portion remaining as the patient’s responsibility, after determining what their insurance will pay, will be adjusted such that the maximum amount of the patient’s responsibility will be that of the fee scale for which they qualify based on their household income.
9. Any patient seeking services from PATHS Dental Center other than those listed in Appendix A will be offered a discount as follows: Slide A will receive a 50% discount, and Slide B will receive a 25% discount.
10. Any patient found to be ineligible for Slide A or Slide B will be required to pay 100% of any cost per procedure according to the Dental Center’s fee schedule.