BC 1991 06 17 - Laserfiche WebLink

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WOMEN'S HEALTH SECTION SLIDING FEE SCALE MONTHLY GROSS INCOME FOR USE IN FAMILY PLANNING AND MCH PROGRAMS CABARRUS COUNTY HEALTH DEPARTMENT MATERNAL HEALTH PROGRAM FEE SCALE - (GROSS INCOME) 100% OF FAMILY ZERO PAY TWENTY PERCENT FORTY PERCENT SIXTY PERCENT EIGHTY PERCENT FULL PAY POVERTY SIZE PAY PAY PAY PAY BEGINS $552 1 $0 to $552 $553 to $690 $691 to $828 $829 to $965 $966 to $1102 $1103 $740 2 $0 to $740 $741 to $925 $926 to $1110 $1111 to $1295 $1296 to $1479 $1480 $928 3 $0 to $928 $929 to $1160 $1161 to $1393 $1394 to $1625 $1626 to $1856 $1857 $1117 4 $0 to $1117 $1118 to $1396 $1397 to $1675 $1676 to $1954 $1955 to $2232 $2233 $1305 5 $0 to $1305 $1306 to $1631 $1632 to $1958 $1959 to $2284 $2285 to $2609 $2610 $1493 6 $0 to $1493 $1494 to $1867 $1868 to $2122 $2123 to $2613 $2614 to $2986 $2987 $1682 7 $0 to $1682 $1683 to $2102 $2103 to $2523 $2524 to $2943 $2944 to $3362 $3363 $1870 8 $0 to $1870 $1871 to $2338 $2339 to $2805 $2806 to $3273 $3274 to $3739 $3740 $2058 9 $0 to $2058 $2059 to $2573 $2574 to $3088 $3089 to $3602 $3603 to $4116 $4117 $2247 10 $0 to $2247 $2248 to $2808 $2809 to $3370 $3371 to $3932 $3933 to $4492 $4493 $2435 11 $0 to $2435 $2436 to $3044 $3045 to $3653 $3654 to $4261 $4262 to $4689 $4870 $2623 12 $0 to $2623 $2624 to $3279 $3280 to $3935 $3936 to $4591 $4592 to $5246 $5247 INSTRUCTIONS: AFTER DETERMINING SLIDING SCALE PAY CATEGORY, FIND DOLLAR AMOUNT OF CHARGE ON APPROPRIATE SCHEDULE. NOTE: NO CHAROES MAY BE ASSESSED IF PATIENT IS MEDICAID ELIGIBLE. WOMEN'S HEALTH SECTION 4/29/91 Complete (initial visit) Revisit (subsequent visit) Rhogam (for Rh negative patients) Non-Stress Fetal/Test $10.00 $20.00 $30.00 $40.00 $50.00 $ 7.00 $14.00 $22.00 $29.00 $36.00 $ 7.00 $14.00 $21.00 $28.00 $35.00 $ 5.00 $10.00 $15.00 $20.00 $25.00 Eligibility will be determined with each pregnancy. Income will be determined by declaration of income by patient; however, verification can be requested at the discretion of the eligibility specialist. Patients will be expected to pay according to the above fee scale. Patients on sliding fee scale who fail to pay during a pregnancy and return to the health department for care with subsequent pregnancy will be referred to the program supervisor or nursing director prior to acceptance for care. Patients with hospital insurance and excessive income will be referred to private care. If the patient is unable to obtain medical care within Cabarrus County (i.e., lack of up-front funds, owes doctor for previous services, doctors' appointments filled) patient can receive care at the Cabarrus County Health Department. Eligibility specialist will verify/document (using special form) that "patient is unable to receive care." Insurance patients will be placed in the full pay category regardless of income. Insurance will be filed by the health department.