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CABARRUS COUNTY HEALTH DEPARTMENT <br />MATERNAL HEALTH PROGRAM FEE SCALE (GROSS INCOME) <br /> <br />Family No 20% 40% 60% 80% Full <br />Size Pay Pay Pay Pay Pay Pay <br /> <br /> 1 <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br />10 <br /> <br />$0- 6 279 <br />$0- 8 419 <br />$0-10 559 <br />$0-12 699 <br />$0-14 839 <br />$0-16 979 <br />$0-19 119 <br />$0-21 259 <br />$0-23399 <br />$0-25 539 <br /> <br />$ 6,280-$ 7 849 <br />$ 8,420-$10 524 <br />$10,560-$13 199 <br />$12,700-$15 874 <br />$14,840-$18 549 <br />$16,980-$21 224 <br />$19,120-$23 899 <br />$21,260-$26 574 <br />$23,400-$29 249 <br />$25,540-$31 924 <br /> <br />$ 7 850-$ 9 419 <br />$10 525-$12 629 <br />$13 200-$15 839 <br />$15 875-$19 049 <br />$18 550-$22 259 <br />$21 225-$25 469 <br />$23 900-$28679 <br />$26 575-$31889 <br />$29 250-$35 099 <br />$31 925-$38 309 <br /> <br />$ 9,420-$10 989 <br />$12,630-$14 734 <br />$15,840-$18 479 <br />$19~050-$22 224 <br />$22,260-$25 969 <br />$25,470-$29 714 <br />$28,680-$33 459 <br />$31,890-$37 204 <br />$35,100-$40 949 <br />$39,310-$44 694 <br /> <br />$10,990-$12 559 <br />$14,735-$16.839 <br />$18,48o-$21 119 <br />$22,225-$25.399 <br />$25,970-$29 679 <br />$29,715-$33 959 <br />$33,460-$38 239 <br />$37,205-$42 519 <br />$40,950-$46 799 <br />$44,695-$51 079 <br /> <br />$12,560+ <br />$16,840+ <br />$21,120+ <br />$25,400+ <br />$29,680+ <br />$33,960+ <br />$38,240+ <br />$42,520+ <br />$46,800+ <br />$51,080+ <br /> <br />For family units with more than 10 members, add $2,140 for each additional member. <br /> <br /> Complete (initial visit) $10.00 <br /> Revisit (subsequent visit) $ 7.00 <br /> Rhogam (for Rh negative patients) $ 7.00 <br /> Non-Stress Fetal/Test $ 5.00 <br />Eligibility will be determined with each pregnancy. <br /> <br /> $2O.00 $30.00 $40.00 $50.00 <br /> $14.00 $22.00 $29.00 $36.00 <br /> $14.00 $21.00 $28.00 $35.00 <br /> $10.00 $15.00 $20.00 $25.00 <br />Income will be determined by declaration of income by patient; however, verification <br /> <br />can be requested at the discretion of the eligibility specialist. Patients will be expected to pay according to the above fee scale. <br /> Patients on sliding fee scale who fail to pay during a pregnancy and return to the health department for care with subsequent pregnancy <br />will be referred to the program supervisor or nursing director prior to acceptance for care. <br /> Patients with hospital insurance and excessive income will be referred to private care. If the patient is unable to obtain medical care <br />within Cabarrus County (i.e., lack of up-front funds, owes doctor for previous services, doctors' appointments filled) patient can receive care <br />at the Cabarrus County Health Department. Eligibility specialist will verify/document (using special form) that "patient is unable to receive <br />care." <br /> Insurance patients will be placed in the full pay category regardless of income. Insurance will be filed by the health department. <br /> <br /> <br />