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CABARRUS COUNTY HEALTH DEPARTMENT
<br /> MATERNAL HEALTH PROGRAM FEE SCALE - (GROSS INCOME)
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<br /> Pim~ ~ Pa~ z-aX P-~ Pax
<br /> 1 S0- 5,769 S 5,770- 7,212 $ 7,213-$ 8,655 $ 8,656-$10,098 $10~099-$11,539
<br /> 2 $0- 7,729 S 7~730- 9~652 S 9,663-$11,595 $11.$96-$13~528 $13,529-$15,459
<br /> 3 $0- 9,689 $ 9,690-12,112 $12,113-$14,$35 $14,536-$16,958 $16~959-$19,379 $19,380+
<br /> 4 $0-11,649 $11,650-14~562 $14,565-$17,475 $17,476-$20~388 $20,389-$23,299
<br /> 5 $0-13,60q $13)610-17,012 S17,013-$20,415 $20)416-$25~818 $23,819-$27,219
<br /> 6 $0-~5,569 $15,570-19,462 $19,&63-$23,355 $23,356-$27,248 $27,249-$31,139 $31,140+
<br />m
<br /> 7 $0-17~529 $17,530-21,9!2 $21,913-$26,295 $26,296-$30,678 S30,679-$35,059 $35,060+
<br /> 8 $0-19,489 $19,490-24,362 $2&,363-$29,235 $29,236-$34,108 $34,109-$59,979 $39,980+
<br /> 9 $0-21,449 $21,450-26,812 $26,813-$32,175 $32,176-$37,538 $37,$39-$42,899 $42,900+
<br /> 10 $0-23,~09 $23,410-29,262 $29,263-$35,115 $35,116-$40,968 $40,969-$46,819 $46,820+
<br /> For family units with more than 10 members~ adU $1,960 for each addi~ioeal member.
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<br /> 1st trimester Complete (initial visit) $10.00 $20.00 $30.00 $40.00 $50.00
<br /> Revisit (subsequent visit) $ 7.20 S14.40 $21.60 $28.80 $36.00
<br /> Rhogam (for Rh negative patients) $ 7.00 S14.00 $21.00 $28.00 $35.00
<br /> 2nd trimester Complete (initial visit) $14.00 $28.00 $42.00 $56.00 $70.00
<br /> P~visit (subsequent visit) $ 8.80 $17.60 $26.40 $35.20
<br /> 3rd trimester Complete (initial visit) $17.00 $34.00 $51.00 $68.00 $85.00
<br /> Revisit (subsequent visit) $14.20 $28.40 $42.60 $56.80 $71.00
<br /> Eligibility will be determined with each pregnancy. Income will be determined by declaration of income by patient;
<br /> accordingh°wever" verificationto the aboveCanfeebescale.requested at the discretion of the eligibility~ specialis~. Patients will be expected to pay
<br /> Patients on sliding fee scale who fail to pay during a pregnancy and return to the health department for care with a
<br /> subsequent pregnancy will be referred to the program supervisor or nursing director prior to acceptance for care.
<br /> Patients wtthhospftal insurance and excessive income will be
<br /> obtain medical care within Caharrus County (i.e., lack of up-front referred to private care. If the patient is unable to
<br /> funds, owes doctor for previous serVices, doctors'
<br /> appointments filled) patient can receive care at the Cabarrus County Health Department. Eligibility specialist will
<br /> verify/document (using special form) that "patient is unable to receive care."
<br /> Insurance patients will be placed in the full pay category regardless of income. Insurance will be filed by the health
<br /> department.
<br /> 07/01/87 (Revised to be effective 07/01/88)
<br /> 07-21-87: Approved byCabarrus County Board of Health and County Commissioners, to be effective 07-21-87.
<br /> 12-07~87: Fee scale revised by Cabarrus County Board of Healtk and County' Commissioners, to be effective 12-07-87.
<br /> 06-06-88: Approved by Cabarrus County BnmrM m~ Health to be. effective 0~201-88'
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