Get the free 4002 Sliding Fee Scale - Bullhook Community Health Center
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521 4th Street Have, Montana 59501 Phone: 4063954305 Fax: 4063955643 www.bullhook.com POLICY SLIDING FEE SCALE 4002 It is the policy of Billhook Community Health Center, Inc. to accurately invoice
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How to fill out 4002 sliding fee scale
How to fill out 4002 sliding fee scale:
01
Gather all necessary information and documents required for the form.
02
Start by providing personal information such as name, address, and contact details.
03
Indicate the household size by including the number of individuals living in the household.
04
Specify the annual household income, including any additional sources of income.
05
Include information about any health insurance coverage currently held by the individual or household members.
06
Determine the percentage of the federal poverty level that applies to the household income.
07
Calculate the sliding fee scale percentage based on the determined federal poverty level percentage and indicate it in the form.
08
Sign and date the form to complete the filling process.
Who needs 4002 sliding fee scale:
01
Individuals or families with limited financial resources who are seeking affordable healthcare services.
02
Low-income individuals who may not qualify for other assistance programs but still require access to subsidized healthcare.
03
Those who are uninsured or underinsured and need assistance in covering medical expenses based on their income level.
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