Financial Assistance
Sliding Fee Discount Program Information
What is the Sliding Fee Discount Program?
It is the policy of Heartland Health Services to provide patient-centered primacry care regardless of the patient's ability to pay. Discounts are offered based upon household income and the number of persons living in the household. A sliding fee schedule is used to calculate the basic discount and is updated each year using federal poverty guidelines. Once approved, the discount will be applied to servicews, between 3 monthsto 12 months if approved, after which the patient must reapply.
The Sliding Fee Discount Program is part of a federal program (Federally Qualified Health Centers - FQHC) that allows Heartland Health Services to discount normal charges for medical visits for our qualifying patients based on household size and household income. In order to qualify for the program, patients must provide proof of income below 200% of the current federal poverty level.
The Sliding Fee Discount is available to all unisured patients. If you have insurance coverage, Heartland Health Services is required by the FQHC program to bill your insurance for your medical visit charges. You may be responsible for insurance co-pays in this situation. If you have co-insurance or a high deductible, you may submit an application for the Sliding Fee Discount to apply to the patient responsibility portion of the charges.
Depending on household size and household income, patients are assigned a discount tier or full fee, Category A, B, C or D. The minimum fee charged for each tier is shown in the chart below:
|
DISCOUNT TIER:
MINIMUM FEE: |
Category A
$25.00 |
Category B
$30.00 |
Category C
$35.00 |
Category D
$40.00 |
Full Fee
Full Charge |
Patients that qualify for the discounted fees are responsible only for the minimum fee in their respective tier and are expected to pay the discounted fee at the time of service.
How do I sign up for the Sliding Fee Discount Program?
- Complete the Financial Assistance (FA) application. Instructions are included on the application. Please feel free to ask the front desk personnel if you have any questions or if you need assistance completing the application.
- Next, you will need to provide proof of income, including the following if applicable:
- Social Security Income
- Pension/Retirement Income
- Alimony Received
- Unemployment Compensation
- Disability or Supplemental Security Income (SSI)
- Rents and/or Royalties Received
- Attach proof of income - Examples of acceptable proof listed below (copies are acceptable):
- Prior 2 months worth of Paystubs
- Prior 2 months of Bank Statements
- Income Tax Return for the most recent year
- Unemployment Verification (Benefit Statement)
- Court Documents (Alimony and /or child Support)
- Benefit Letter (SSI and Social Security recipients, Pension/Retirement recipients)
- Submit your application with all attached proof to any of the clinics at Heartland Health Services or mail to:
Heartland Health Services
Attn: Financial Assistance
2214 N University
Peoria, IL 61604 - If you have any questions about financial assistance or filling out the FA application, please contact Celia at (309) 680-7631
- Please note: Financial Assistance Applications will only be retroactive effective 90 days from the date of applications receipt or approval.
DOWNLOAD THE APPLICATION IN ENGLISH HERE
