Valley Family Health Care Locatjons: Payetue Medical Ontario Dental - PowerPoint PPT Presentation

Valley Family Health Care Locatjons: Payetue Medical Ontario Dental 2327 SW 4th Ave 1441 NE 10th Ave Payetue, ID Ontario, OR vfic.org 541 - 889 - 0052 208 - 642 - 9376 Follow us on Facebook @VFHC1 Payetue Dental Nyssa Medical 17 S 3rd St 1501 NE 10th Ave Nyssa, ID Payetue, ID 208 - 642 - 9379 541 - 372 - 5738 Valley Family Health Care ofgers discounted services based on the size of the Dental Nominal Charges: patjent ’ s household and income. The Sliding Fee Scale is determined by calculatjng the family ’ s gross monthly income and the number of people supported in the Dental Treatment Procedures: Nyssa Dental New Plymouth household. Medical 17th N 6th St Please request nominal charge list from a Nyssa, ID 300 N Plymouth VFHC Dental Receptjonist. In order to qualify for the sliding fee , the patjent must fjll out an applicatjon and New Plymouth, ID 541 - 372 - 2606 provide proof of current or annual income . Proof of income can be one of the Dental Full or 208 - 278 - 3335 following: $20 Limited Exam • Pay stub • Bank Statement (showing deposits) Emmetu Medical Vale Medical Dental Hygiene • $20 Unemployment/Employment verifjcatjon statement from the state 789 Washington W Appointment 207 E 12th St Employment offjce Vale, ID Emmetu, ID • Taxes (last year ’ s) Dental Full Exam 541 - 473 - 2101 208 - 365 - 1065 • $45 Social Security or Disability print out from Medicare with X - Rays • Letuers from the patjent ’ s employer Medical, Behavioral Health, etc. Treasure Valley Ontario Medical Nominal Charges: *VFHC Stafg will verify proof of income once received. Pediatric Clinic 2327 SW 4th Ave 1219 SW 4th Ave, Ontario, OR The patjent will have to update income informatjon every year. Suite 1 Visits $20 541 - 889 - 0052 Insured patjents that qualify for the sliding fee may receive the discount. First, the Ontario, OR patjent ’ s insurance plans are billed. Based on the amount of the insurance Labs In—House $10 541 - 889 - 2668 payment, deductjble, pre - existjng conditjons, covered services, etc. the patjent Procedures (See Front Desk for List) $75 may get a sliding fee adjustment. Patjents may receive a discount of 25%, 50%, or 75% for medical and behavioral Immunizatjon health services and 25%, 40%, or 50%, for dental services based on income and $7 Administratjon number of people supported in the household. For patjents 100% or below the Federal Poverty Level, a nominal charged is applied. Note: No patjent shall be denied service due to an individual ’ s inability to pay.

Medical & Behavioral Health Sliding Fee Scale Sliding Fee Discount Based on Federal Register 2018 – Poverty Income Guidelines % of Federal Poverty Income Guidelines Family Income Code 0 Code 25 Code 50 Code 75 Code 100 Size Measure Up to 100.00% 100.01% - 149.99% 150.00% - 174.99% 175.00% - 200.00% 200.01% + Annual $0 — $ 12,140 $ 12,141 — $ 18,209 $ 18,210 — $ 21,244 $ 21,245 — $ 24,280 $ 24,281 + 1 Monthly $0 — $ 1,012 $ 1,013 — $ 1,517 $ 1,518 — $ 1,770 $ 1,771 — $ 2,023 $ 2,024 + Annual $0 — $ 16,460 $ 16,461 — $ 24,688 $ 24,689 — $ 28,803 $ 28,804 — $ 32,920 $ 32,921 + 2 Monthly $0 — $ 1,372 $ 1,373 — $ 2,057 $ 2,058 — $ 2,400 $ 2,401 — $ 2,743 $ 2,744 + Annual $0 — $ 20,780 $ 20,781 — $ 31,168 $ 31,169 — $ 36,363 $ 36,364 — $ 41,560 $ 41,561 + 3 Monthly $0 — $ 1,732 $ 1,733 — $ 2,597 $ 2,598 — $ 3,030 $ 3,031 — $ 3,463 $ 3,464 + Annual $0 — $ 25,100 $ 25,102 — $ 37,647 $ 37,648 — $ 43,922 $ 43,923 — $ 50,200 $ 50,201 + 4 Monthly $0 — $ 2,092 $ 2,093 — $ 3,137 $ 3,138 — $ 3,660 $ 3,661 — $ 4,183 $ 4,184 + Annual $0 — $ 29,420 $ 29,421 — $ 44,127 $ 44,128 — $ 51,482 $ 51,483 — $ 58,840 $ 58,841 + 5 Monthly $0 — $ 2,452 $ 2,453 — $ 3,677 $ 3,678 — $ 4,290 $ 4,291 — $ 4,903 $ 4,904 + Annual $0 — $ 33,740 $ 33,741 — $ 50,607 $ 50,608 — $ 59,042 $ 59,043 — $ 67,480 $ 67,481 + 6 Monthly $0 — $ 2,812 $ 2,813 — $ 4,217 $ 4,218 — $ 4,920 $ 4,921 — $ 5,623 $ 5,624 + Annual $0 — $ 38,060 $ 38,061 — $ 57,086 $ 57,087 — $ 66,601 $ 66,602 — $ 76,120 $ 76,121 + 7 Monthly $0 — $ 3,172 $ 3,173 — $ 4,757 $ 4,758 — $ 5,550 $ 5,551 — $ 6,343 $ 6,344 + Annual $0 — $ 42,380 $ 42,381 — $ 63,566 $ 63,567 — $ 74,161 $ 74,162 — $ 84,760 $ 84,761 + 8 Monthly $0 — $ 3,532 $ 3,533 — $ 5,297 $ 5,298 — $ 6,180 $ 6,181 — $ 7,063 $ 7,064 + + $4,320 Annual/ + $4,320 Annual/ + $4,320 Annual/ + $4,320 Annual/ + $4,320 Annual/ *Each additjonal family member + $360 Monthly + $360 Monthly + $360 Monthly + $360 Monthly + $360 Monthly Code 25: Patjents pay 25% of fee* Code 0: Nominal Charges Sliding Fee Code 50: Patjents pay 50% of fee* Visits $20 Code 75: Patjents pay 75% of fee* Discount Classes Labs In—House $10 Patjents are ineligible for discounts; Procedures (See Front Desk for List) $75 Code 100: Note: No patjent shall be Pay 100% of fee Immunizatjon Administratjon $7 denied service due to an * But not less than the nominal charge individual ’ s inability to pay.

Dental Sliding Fee Scale Based on Federal Register 2018 – Sliding Fee Discount Poverty Income Guidelines % of Federal Poverty Income Guidelines Family Income Code 0 Code 50 Code 60 Code 75 Code 100 Size Measure Up to 100.00% 100.01% - 149.99% 150.00% - 174.99% 175.00% - 200.00% 200.01% + Annual $0 — $ 12,140 $ 12,141 — $ 18,209 $ 18,210 — $ 21,244 $ 21,245 — $ 24,280 $ 24,281 + 1 Monthly $0 — $ 1,012 $ 1,013 — $ 1,517 $ 1,518 — $ 1,770 $ 1,771 — $ 2,023 $ 2,024 + Annual $0 — $ 16,460 $ 16,461 — $ 24,688 $ 24,689 — $ 28,803 $ 28,804 — $ 32,920 $ 32,921 + 2 Monthly $0 — $ 1,372 $ 1,373 — $ 2,057 $ 2,058 — $ 2,400 $ 2,401 — $ 2,743 $ 2,744 + Annual $0 — $ 20,780 $ 20,781 — $ 31,168 $ 31,169 — $ 36,363 $ 36,364 — $ 41,560 $ 41,561 + 3 Monthly $0 — $ 1,732 $ 1,733 — $ 2,597 $ 2,598 — $ 3,030 $ 3,031 — $ 3,463 $ 3,464 + Annual $0 — $ 25,100 $ 25,102 — $ 37,647 $ 37,648 — $ 43,922 $ 43,923 — $ 50,200 $ 50,201 + 4 Monthly $0 — $ 2,092 $ 2,093 — $ 3,137 $ 3,138 — $ 3,660 $ 3,661 — $ 4,183 $ 4,184 + Annual $0 — $ 29,420 $ 29,421 — $ 44,127 $ 44,128 — $ 51,482 $ 51,483 — $ 58,840 $ 58,841 + 5 Monthly $0 — $ 2,452 $ 2,453 — $ 3,677 $ 3,678 — $ 4,290 $ 4,291 — $ 4,903 $ 4,904 + Annual $0 — $ 33,740 $ 33,741 — $ 50,607 $ 50,608 — $ 59,042 $ 59,043 — $ 67,480 $ 67,481 + 6 Monthly $0 — $ 2,812 $ 2,813 — $ 4,217 $ 4,218 — $ 4,920 $ 4,921 — $ 5,623 $ 5,624 + Annual $0 — $ 38,060 $ 38,061 — $ 57,086 $ 57,087 — $ 66,601 $ 66,602 — $ 76,120 $ 76,121 + 7 Monthly $0 — $ 3,172 $ 3,173 — $ 4,757 $ 4,758 — $ 5,550 $ 5,551 — $ 6,343 $ 6,344 + Annual $0 — $ 42,380 $ 42,381 — $ 63,566 $ 63,567 — $ 74,161 $ 74,162 — $ 84,760 $ 84,761 + 8 Monthly $0 — $ 3,532 $ 3,533 — $ 5,297 $ 5,298 — $ 6,180 $ 6,181 — $ 7,063 $ 7,064 + * Each additjonal + $4,320 Annual/ + $4,320 Annual/ + $4,320 Annual/ + $4,320 Annual/ + $4,320 Annual/ family member + $360 Monthly + $360 Monthly + $360 Monthly + $360 Monthly + $360 Monthly Code 0: Nominal Charges Code 50: Patjents pay 50% of fee* Dental Full or Limited Exam $20 Code 60: Patjents pay 60% of fee* Sliding Fee Dental Hygiene Appointment $20 Code 75: Patjents pay 75% of fee* Discount Classes Dental Full Exam with X - Rays $45 Patjents are ineligible for discounts; Code 100: Note: No patjent shall be Dental Treatment Procedures: Pay 100% of fee denied service due to an Please request nominal fee list from Receptjonist * But not less than the nominal charge individual ’ s inability to pay.