|
m
<br />
<br /> CABARRUs COUNTY HEALTH DEPARTMENT
<br /> MATERNAL HEALTH PROGRAM FEE SCALE - (GROSS INCOHE)
<br />
<br /> ¥~u~ily No 10__~ 2~ 4._~ 6._~ 80~ Full
<br /> Size ~ ~ ~ ~ ~ e_~ P~y
<br />
<br /> 1 80- 5~499 $ 5,500-$ 6,874 $ 6,875-$ 7,906 $ 7~907-$ 8,937 $ 8,938-8 9,968 $ 9,969-810,999 $tl,000
<br /> 2 $0- 7,399 $ 7,400-$ 9,249 $ 9,250-$10,637 $i0,638-$12,O25 $12,026-$13,412 $13,413-$14,799 $14,800
<br /> 3 $0- 9,299 $ 9,3002511,624 $11,625-$13,368 $13,369-$15,112 $15,113-~16,856 $16,857-$18,599 $18,600
<br /> 4 $0-11,199 $11,200-$13,999 814,000-$16 ~099 $16,100-$18~199 $18,200-$20,299 $20,300-$22,399 $22,400
<br /> 5 $0-13,099 $13,100-~16~374 $16~375-$18~831 $18,832-$21~ 207 $21,288-$23,243 $23,744-$26,199 $26,200
<br /> 6 $0-14~999 $15,000-$18,749 $18 ~750-$21,562 $21~563-$24,375 $24,376-$~?m188 $27~189-$29,999 $30,000
<br /> 7 $0-16}899 $16,900-$21~ 124 $21~125-$24,293 $24~294-$27,~62 $22~463-$30,631 $30,6321533, ~99 $33,800
<br /> 8 $0-18,799 $18,800~$23,&99 $23~ 500-$22,024 $27,025-$30~549 $30~ 550-$34,074 $34,075~$37~599 $37,600
<br /> 9 $0-20,699 $20,700-$25,82~ $25,825-$29~756 $29,75?-$33,637 $33,638-$37,518 $32,519-$41:399 $41,400.
<br /> 10 $0-22~599 $22,600-$28,249 $28~ 250-$32s487 $32,488-$36,7~5 $36,726-$40,962 $40,963-$95~199 $45s 200
<br /> + $1)900 + $1m900 + $2,375 + $2,731 + $3~088 + $3~444 * 3,800
<br />
<br />Complete (initial visit) $ ~.OO $ 8.00 $17.O0 $25.00 $34.00 $42.00
<br />Revisit (subsequent visit) $ 2.00 $ 5.00 $10.00 $14.00 $19.00 $24.00
<br />Rhogam (for Rh negative patients) $-3r88 $-5~08 $t8:08
<br /> $ 3.50 $ 7.00 $1~.00 $21.00 $28.00 $35.00
<br />Eligibility will be determined with each pregnancy. Income will be determined by declaration of income by patient; however,
<br />verification can be requested at the discretion of the eligibility specialist. Patients will be expected to pay according
<br />to the above fee scale.
<br />
<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 />
<br />Pafients with hospital insurance and excessive income will be referred to private care. if the patient is unable to obtain
<br />medical care within Cabarrus County (i.e., lack of up-front funds, owes doctor for previous services, doctors' appointments
<br />fi. lled) patient can receive care at the Cabarrus County Health Department. Eligibility specialist will verify/document
<br />(using special form) that "patient is unable to receiYe care."
<br />
<br />Insurance patients will be placed in the full pay category regardless of income. Insurance will be filed by the health
<br />department. 07/01/87
<br />7-21-87 Approved by Cabarrus Co6nty Board of Health and County Commissioners, to be effective 7-21-87.
<br />
<br />
<br />
|