Our goal is to provide care for all patients who meet our sliding fee discount program eligibility criteria. Fair charges are established using Federal Poverty Level Guidelines, with no discounts for patients above 200% of the poverty level. Patients below 150% of the poverty level are not required to make any payment.

Policy

We will not refuse service to any patient based on their inability to pay for our services. Our registration staff may ask patients to provide information regarding any third-party insurance coverage they may have or provide proof of their inability to pay. Patients who qualify for sliding scale coverage will receive a discount according to the Mayflower Clinic's guidelines.

The sliding fee discount program eligibility of a patient is determined by their ability to pay, which is based on their income and family size as a percentage of the federal poverty guidelines. Mayflower Clinic does not consider any other factors, such as health insurance status, population type, or county of residence, when assessing eligibility. The definitions of Income and Family Size used for this policy are as follows:

a.) Gross annual income refers to the total income earned by all adult family members from various sources such as present and past employment, self-employment, government benefits, child support, court orders, and investment income before taxes and other deductions are made.

b.) Family size includes all individuals in a household, including traditional and non-traditional families, who share financial ties.

After reviewing the patient's proof of income and verifying their support, we will inform them about any potential discounts they may qualify for based on a sliding scale. These discounts will be determined using the most recent Federal poverty guidelines. Patients who earn more than 200% of the FPG will not be eligible for discounts, while those who earn between 150-200% of the FPG will be charged a small fee as determined by the Mayflower Clinic. There is no charge for patients who fall below the 150% FPG.

Patients who cannot provide proper proof of income may reschedule or pay a $35 visit fee. During the eligibility process, we will verify and document the patient's date of birth and current address. Eligibility for sliding scale discounts will be determined quarterly, semi-annually, or annually, depending on the proof of income provided. Patients whose income is not expected to change in the next 12 months will be eligible on an annual basis.

The clinic manager may reduce or waive the sliding fees and/or nominal charges as well as extend the time period for self-attestation of family size and income under the following specific patient circumstances in order to minimize barriers and ensure access to care.

a. Homeless status of the patient, as defined in the HRSA/BPHC Program Assistance Letter 99-12, section II E, with no current income.

b. For purposes of maintaining privacy, confidentiality, and/or patient safety. Examples could include but are not limited to domestic abuse.

c. Exceptional financial, physical, or emotional hardship that would preclude the patient from being able to pay the fee or nominal charge or supply family size and income documentation. Examples could include but are not limited to natural/manmade disasters or crime victims.

Patients qualifying for a sliding scale discount will be expected to pay the discounted fee at the time services are rendered. This payment will cover the office visit, labs, and diagnostic tests if indicated by the provider.

Applicability

This policy applies to all patients seeking the sliding fee discount program from the company.