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<br /> C/L~ARRUS COUN~ HEALTH DEPARTHENT
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<br /> ~TERNAL ~E~ PROG~ FEE SCALE - (GROSS
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<br /> X $0- 5,699 5 5,500-$ 6,876 $ 6,875-5 7,906 $ 7,907-$ 8,937 5 8,938-5 9,9&B
<br /> 2 $0- 7~399 5 7,600-5 9,2G9 5 9,250-510,637 $10,638-522,025 512,026o$13,612
<br /> 3 50- 9,299 5 9,300°$11,626 512,625-$13,358 5'}-3,369°515,112 515,113°$16,856 $16,857-$18,599 $18j600
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<br /> 5 $0-L3,099 9~3,100-$16,376 926,375-928,831 $~8,832°521,287 521,288-$23,763
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<br /> $ 50-16,999 5~5,000-$18,769 $~8,750°521,562 $2X,S&3-524,375 $26,3~6-$27 j288 S27,~89-S29,99g
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<br /> 7 50-16,899 $t6,900-52~,].24 52L,125-$26 )292 526,29~o527)662 iZT,663°$]O,6~L $30)632-$33)799
<br /> 8 50-X8,799 $18,800-$23~99 923,500-$27,026 527,02-5-$30,5&9 530,550-53~,076 53~,075-$37,599 537,600
<br />~ 9 $0-20,699 $20,700-$25,876 525,875-$29,755 529,757-533,637 $33,638-$37,528 537,519-$61,399
<br /> lO $0-22,599 $22,600-528,269 $28,250°$32,687 $32,688-$36,725 S3G,726-9~0,952 $&O,S&3-$b5,~99 $65,200
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<br /> + 51,900 + 51,900 + 52j375 + $2,731 + 53~088 + $3~q4~ + 3,800
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<br /> Complete (initial visit) $ 6.00 5 8.00 $17.00 525.00 $3~.00 $62.00
<br /> eevisit (subsequent visit) $ 2.00 $ 5.00 $10.00 916.00 $19.00 $26.00
<br /> l~o&a= (for gh negative patients). S 3.00 S 5.00 910.00 51.5.00 $20.00 $25.00
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<br /> Eligibility rill be detemiued vith each pregnancy. ~ucome will be deuermined by declaration o£ income by patient; however,
<br /> verification can be requested at :he discretion of the eligibility specialist. PaUteots rill be expected :o pay acco~diug
<br /> to the above fee scale.
<br />
<br /> Patients on slidin8 fee scale vho fail to pay during a pregnancy and ~eturn to the health department for cate rich a
<br /> subsequent pregnaecy ~lll be referred to the program supervisor or nursing director prior to acceptance for cate.
<br />
<br /> Patients vith hospital insurance and excessive income ~ill be referred :o private care. If the patient is uuable to obtain
<br /> me~ical care vfthiu Cabarrus Coun:y (i.e., lack of up-front funds, oyes doctor for previous sex-vices, doctors' appointments ~
<br /> filled) patient can receive care at the Cabarrus County Hea~th Department. Eligibility specialist ~ill verify/document
<br /> (using special form) that "patient is unable to receive care."
<br />
<br /> Insurance patients ~tll be placed in the full pay category regardless of income. ]nsurance ~ill be filed by the health
<br /> depa:tmeuC. 07/01/87
<br /> Adopted by Caba:rus County Boa:d of Health in official session 6-25-87.
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