Sliding Discount Program

Sliding Discount Program

Qualify for Payment Assistance with our Sliding Discount Program

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:

  • All working members of your household

  • Adjusted Gross Income on your Tax Return

  • Unemployment Compensation

  • Workers Compensation

  • Alimony and Child Support

  • Private or Government Pension

  • Annuity or Investment Income

  • Social Security Income (SSI)

  • Disability or SSI Benefits

  • Self-Employed Individuals net income and expenses

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.

Apply for a Sliding Fee Discount

  1. Click to print a Financial Assistance Form.
  2. 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.
  3. 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.
  4. Please sign and date the bottom of the Financial Assistance Forms, saying you have read and understand and accept the above conditions.
  5. 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

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.

  • Medical (including other medical, preventative, lab, x-ray, and nursing home)
  • Behavioral Health
  • Vision
  • 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

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.

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.

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.

Sliding Discount Program Quick Guide

1) Fill out an Application Form

You can access our Financial Assistance Form here. Please print and turn it in to any of our Front Desk Receptionists.

2) Meet With a Front Desk Receptionist

The Front Desk Receptionist will calculate your discount to see if you meet the qualifications.

3) Get Approved

After approval, you’re able to make an appointment for services offered at any Family Health’s locations.

Re-Apply

Applicants will need to reapply for discounts every time their income or family size changes or every 12 months, whichever comes sooner.

Qualify for Payment Assistance with our Sliding Discount Program

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:

  • All working members of your household

  • Adjusted Gross Income on your Tax Return

  • Unemployment Compensation

  • Workers Compensation

  • Alimony and Child Support

  • Private or Government Pension

  • Annuity or Investment Income

  • Social Security Income (SSI)

  • Disability or SSI Benefits

  • Self-Employed Individuals net income and expenses

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.

Apply for a Sliding Fee Discount

  1. Click to print a Financial Assistance Form.
  2. 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.
  3. 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.
  4. Please sign and date the bottom of the Financial Assistance Forms, saying you have read and understand and accept the above conditions.
  5. 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

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.

  • Medical (including other medical, preventative, lab, x-ray, and nursing home)
  • Behavioral Health
  • Vision
  • 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

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.

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.

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.

Sliding Discount Program Quick Guide

1) Fill out an Application Form

You can access our Financial Assistance Form here. Please print and turn it in to any of our Front Desk Receptionists.

2) Meet With a Front Desk Receptionist

The Front Desk Receptionist will calculate your discount to see if you meet the qualifications.

3) Get Approved

After approval, you’re able to make an appointment for services offered at any Family Health’s locations.

Re-Apply

Applicants will need to reapply for discounts every time their income or family size changes or every 12 months, whichever comes sooner.