GVSU Family Health Center
Sliding Fee for Uninsured Patients
The sliding fee scale for uninsured patients allows individuals who qualify to receive discounts on their appointments here at our office. You may apply for this program only if you do not have insurance.
Eligibility is based upon your household income and how many people live with you. This information is used to determine if you qualify for a reduction on the cost of your visits by using standard federal guidelines.
How to Apply
Fill out our Sliding Scale Application and bring it to your appointment (or you may ask our front desk for a copy.) Fill this form out completely and submit it to our office with proof of your income as soon as possible (preferably at the time of your first appointment.)
Proof of Income
Since this scale is based upon household income, you will need to provide income verification for all household members. So for example, if you do not work but your spouse does, include their proof of income. Examples of income verification are:
- Recent paycheck stubs
- Last year’s tax return paperwork
- Unemployment check stub
If you do not have any of these, refer to page 2 of the Sliding Scale Application or contact our billing department at (616) 988-8774 to discuss other options.
Once you have turned in your application, a billing department representative will notify you of your discount within 3-5 business days. You will either receive a discount of 0%, 25%, 50%, 75% or 100%. Your discount does not apply to other procedures such as lab fees or immunizations.
Your minimum payment per appointment will be $15. Depending on your discount, you may owe more at the time of service. If you have a balance after your payment at your appointment, you will need to make monthly payments to pay off the remainder. A statement will be mailed to you once per month with your balance.
When to Apply
You must turn in your completed application and proof of income prior to receiving any discounts. Therefore, to apply for a discount at your first appointment, you must bring in your verification at that time. If you do qualify for a reduction, it will not apply to past appointments.
Is this a free clinic?
- No. All patients are responsible for a portion of the cost of their appointments.
What if I have no income?
- Individuals that are not working or receiving unemployment will need to provide proof of income for their household. If another individual is providing for you financially, this scale will be based upon their income. Please contact our billing department to clarify your proof of income.
Are all services discounted?
- No. Your visit fee is discounted; however laboratory fees, immunizations, special procedures, and more do not qualify for a discount. If you have a question about what services you receive are not discounted, contact our billing department at (616) 988-8774.
Is my income information confidential?
- Yes, all information you provide is kept confidential as with all of your other records at our office. Your income will not affect the care you receive at our office and we welcome you to be a part of our practice.
Page last modified February 18, 2013