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Revision June 2018Greater Ozarks Rural Psychologists (GORP), LLC Sliding Fee Discount Application It is the policy of G.O.R.P. to provide essential services regardless of the patients' ability to

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How to fill out sliding fee scale and

01

Gather all necessary financial information such as income, household size, and expenses.

02

Calculate the total household income after deducting taxes and necessary expenses.

03

Determine the percentage of the Federal Poverty Level (FPL) that corresponds to the household income.

04

Use the sliding fee scale chart provided by the organization to find the appropriate percentage for the patient's income level.

05

Fill out the sliding fee scale form with accurate and updated information.

06

Submit the completed form along with any required documentation to the organization for review and approval.

Who needs sliding fee scale and?

01

Individuals and families with low to moderate incomes who may not be able to afford full-priced healthcare services.

02

Patients who do not have insurance coverage or have limited coverage for medical expenses.

03

Uninsured or underinsured individuals who require medical treatment but have financial constraints.

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What is sliding fee scale?

Sliding fee scale is a financial aid program that allows individuals to pay for services based on their income level.

Who is required to file sliding fee scale?

Healthcare facilities and providers that offer sliding fee scale services are required to file it.

How to fill out sliding fee scale?

To fill out a sliding fee scale, individuals need to provide information about their income, family size, and household expenses.

What is the purpose of sliding fee scale?

The purpose of sliding fee scale is to ensure that individuals with lower income levels can access healthcare services at affordable rates.

What information must be reported on sliding fee scale?

The information reported on a sliding fee scale includes income, family size, and proof of household expenses.

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