Qualify for Payment Assistance with our Sliding Discount Program
Family Health Services of Darke County, Inc. offers a program that reduces the cost of care for uninsured patients or can be applied to insurance deductibles for patients with insurance.
It is our mission to provide essential services regardless of ability to pay.
Discounts are offered depending upon household income and family size. A “Family” is one or more persons living in one dwelling place. This could include yourself, spouse or significant other, children under 18, parents, grandparents, adult children, etc. Ask any front desk receptionist for more clarification.
Household Income Should Include:
Once qualified, discounts will apply for 12 months. If there are any changes to your Household Income, you are required to update us immediately pursuant to the change. To continue receiving a discount you will need to complete a new application every 12 months.
Sliding Discount Program Income Levels
The Sliding Fee Discount Schedule is used to determine the discount a patient is eligible to receive on their total charges for services. The schedule can change from year to year, and the scale below should be used as reference only. Sliding scale level will be determined on application submission.
Sliding Discount Program Quick Guide
Apply for a Sliding Fee Discount
- Click to print a Financial Assistance Form.
- Enter all your family members and their date of births in the top section. If you need more family member boxes, find space on the form or submit a separate written list.
- Include all working household members, place of employment, and the gross income.
a. If a family member of working age has no income, please complete the No Proof of Income Form for that family member and have them sign.
- Please sign and date the bottom of the Financial Assistance Forms, saying you have read and understand and accept the above conditions.
- Bring your form in to any front desk receptionist and they will determine if you qualify and complete the bottom sections.
If you prefer to apply in person, just stop in at any of our locations and see a front desk receptionist.
Frequently Asked Questions
How do I get started and apply?
- To get started, you'll first need to submit a Financial Assistance Application. This can be done printout our online application form or visiting a front desk receptionist. Please click the link above.
What services can I access?
- Medical (including other medical, preventative, lab, x-ray, and nursing home)
- Behavioral Health
- Adherence Packing Visits
- Pharmacy (with a $5 minimum) (per prescription)
- Dental (per visit, tooth, quadrant, arch, procedure, appliance, etc.)
- OB Global with Delivery
- OB Delivery Only
Are certain services excluded from the Sliding Fee Program?
- The majority of services are included. There are certain exclusions for high-cost medications and supplies included but not limited to, IUDs, implantable birth control devices, opioid drugs, cosmetic dental goods and sleep apnea appliances.
- Also not included are Eyecare Goods, such as glasses, contacts, and other Eyecare supplies.
What if I make more than 200% Poverty Level and don't qualify for the sliding fee discount?
- We cannot give a sliding-fee discount to those over 200% of poverty level per our grant's regulations, but we can offer a prompt-pay discount.
- o A Prompt-Pay discount is for patients who pay in full at the time of service. The discount is subject to change at any time and has a few exclusions, but typically 20% for Vision and Dental office visits and 30% for Medical and Behavioral Health office visits.