Dental - Sliding Scale
SLIDING SCALE DISCOUNT SCHEDULE - DENTAL
The amount that you will be responsible for paying will be determined using a Sliding Scale Discount Schedule which is based on your total income as it relates to the Federal Poverty Level (FPL) Guidelines for this year. The Sliding Scale Discount Schedule is included in this notice.
Documentation of income and number in household must be provided to the Shortgrass Community Health Center business office to determine the eligibility and amount of discount for services to be provided. Patients whose income does not exceed 100% of the FPL for this year may be eligible for a full discount, excluding copayment.
ALL PATIENTS WILL BE SEEN REGARDLESS OF ABILITY TO PAY.
A minimum copayment in the amount of $35.00 for services provided in the dental clinic. Any attempt to falsify information relating to income or other eligibility requirements is a violation of federal law and is subject to prosecution.
PLEASE NOTE: The Shortgrass Community Health Center Sliding Scale Discount Schedule - Dental is based on the 2015 Federal Poverty Level (FPL).