SLIDING FEE PROGRAM
This special program at the Frederiksted Health Care, Inc. is to assist those who have difficulty paying for medical care. Frederiksted Health Care, Inc. is required to charge a fee for medical services and to collect monies when services are rendered. We strive to provide quality accessible medical care to all individuals, regardless of ability to pay. To ensure that we are able to provide this care, our Health Center is able to provide discount fees to patients who are eligible for our Sliding Fee Program.
Discounts are based on calculations of your income and family size, which can reduce your bill 75%, 50%, 25% or more. The discounts apply to all services offered at the Frederiksted Health Center facility. Application for sliding fee discount is voluntary, and you may elect to pay the full fee if you desire. All individuals are encouraged to apply for the sliding fee. In the event that you do not qualify, we will be happy to arrange a payment plan to suit your budget.
If you feel that you may be eligible for a discount, please fill-out the application form. You can apply any time of the year. You may qualify whether you have Private Insurance or Medicare. Once you qualify, your enrollment ends at the end of each year (December 31st). You must notify us of any changes in your income throughout the year, and it is your responsibility to re-apply every year.
If you wish to apply the sliding fee to your current visit, you will need to return the completed application and submit your verification data within five (5) working days of the visit.
CLICK BELOW TO DOWNLOAD APPLICATION FORMS:
- Sliding Fee Application
- Registration Form
- Consent for Treatment (Espanol)
- Consent For Treatment (English)
When you fill-out the application, you must attach any of the following documentation that applies to you as proof of current monthly family income:
- Two consecutive check stubs – if paid Bi-weekly
- Social Security Letter or Disability
- Four consecutive check stubs – if paid weekly
- Public Assistance Letter
- Employer’s Letter on original company’s letterhead
- Notarized letter of the person who supports you
- Income Tax (Recent) – If you are self-employed
- Notarized Letter of any adult not working
- W-2’s (Recent)
- Child Support or Alimony
Also, the following documentation as PROOF OF FAMILY SIZE is required:
- Picture Identification Card: For the adult(s) only (Drivers License, Passport, Employer’s ID, etc.)
- Insurance Card
- Social Security Card: For the patient(s)
- Birth Certificate: For all dependant children
- Mailing Address:(WAPA Bill, Telephone or Cable Bill, or any Bill sent to you by mail.)
If you are unable to provide this information, please speak with the Registration clerk, or if there are special issues you would like us to consider when we review your application, please write them on a separate piece of paper or call us at 772-0260 for more information.