HCC Network

Sliding Scale Eligibility Application

Slide Fee FAQs

 

What is a sliding fee scale?

A sliding scale fee is a discount that helps make healthcare more affordable. It’s based on your income and how many people live in your household.

Do I have to be uninsured to qualify?

No! You can apply even if you have insurance—especially if you have high out-of-pocket costs or limited coverage.

How do I apply?

Simply fill out a short application on our website under Patient Resources>Sliding Scale Eligibility Application and provide proof of income. Our staff can help you through the process.

What documents do I need to provide?

Please bring one or more of the following:

  • Recent pay stubs (last 2–4 weeks)
  • Most recent tax return
  • Social Security or unemployment income letter
  • SNAP/food stamp verification or other options listed on the application

Is my information kept private?

Absolutely. Your personal and financial information is protected and kept confidential.

Will I need to re-apply?

You must reapply once every 12 months, or sooner if your income or family size changes.

What services are covered under the sliding scale?

  • Medical visits
  • Behavioral health
  • Dental care
  • Not Covered: Dental labs, materials and supplies prepared off-site
  • Ask us what’s covered—we’re happy to help!

Can I still get the discount if I can’t bring in documents right away?

Sliding Scale Fee Schedule

(click to enlarge)

Patient Portal Login
Other Forms

Income Declaration Statement

Employment Verification Form