RHMPI ensures that no one will be denied access to quality affordable healthcare services due to their inability to pay.
Our financial assistance sliding-fee program allows us to reduce or “slide” the fees for the care that you and your family receive. If eligible for the Program, your bill will always be at least $15 for medical services; $35 for dental, $30 for vision, behavioral health, and podiatry; and $10 for lab services. This minimum amount is due at the time of your visit, as well as payment for any other unpaid balances.
Financial assistance is available on the basis of documented financial need when there are no additional forms of payment available. No patient will be denied financial assistance on the basis of age, sex, or sexual orientation, race, religion or national origin. RHMPI will provide a copy of the financial assistance application to all patients at time of registration and will be kept on file in the event there is a need for assistance with patient treatment cost/share. This form will be reviewed once the patient requests financial assistance and provides additional supporting documentation. We utilize the standardized financial assistance application to review the applicable patient’s account balance, medication adherence, and appointment compliance.
RHMPI financial assistance process includes:
- Patients who are identified as unable to pay for medically necessary healthcare services must request assistance.
- Patients will submit a completed Financial Assistance Application and all supporting documentation (proof of income, identification, and household size).
- Patients are screened for presumptive eligibility and applicable documents are reviewed based on all qualifying factors.
- Patients are notified of their approval or denial and the amount of associated financial assistance prior to providing services and prior to the issuance of any bill for such services.
RHMPI provides the following types of financial assistance for Medically Necessary Services:
- Universal Exams/Testing
- Copay Assistance on prescription medications, office visits, labs, other services.
You can apply for the program if you need assistance to help you pay for your care. To apply for the sliding fee program, please provide your most recent pay stubs for the last 30 days, current personal income tax return, or an unemployment benefit statement. Eligibility is based on household income and family size.
You can visit one of our Community Health Centers or download the Sliding-Fee Application
Required Eligibility Documents
1) Proof of Income for the Last 30 Days:
Physical document of any income you or a family member in the household may have. Examples pay stubs, child support, social security award letter, etc.
2) Proof of Address:
Provide your most current utility bill with the applicant’s name or spouse’s name or provide a statement from the person you are residing with.
3) Proof of Personal Identification:
Provide original or legible copies of Photo I.D., Birth Certificates and Social Security Cards for everyone in the home.
4) Proof of Insurance:
If any member of your household has private medical insurance, Medicaid, or Medicare, please provide a copy of their insurance card.