SLIDING FEE SCALE PROGRAM
At Friends For All Clinic, we welcome all patients regardless of insurance status. We participate with most major insurers, including Medicare and Medicaid, and we offer financial assistance through a Sliding Fee Discount Program (SFDP) for medical office, prescription, behavioral health, and medical nutrition services. Click the button below to download and submit an application using the form below.
our sliding fee scale
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A sliding fee is a discount on the medical services Friends provides you. This discount is based on your household size and income.
How much will I have to pay? Depending on your income, a sliding fee will be a flat-rate dollar amount from $10-$50. Fees are due at the time of service.
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Eligibility is based on the total number of people in your family and your total household income.
The sliding fee program is to assist patients as a “last resort.” You must inform us if you have insurance. If you have an unpaid balance after your insurance company has paid your claim, you may qualify for the sliding fee discount for the portion you are responsible for paying.
Each sliding fee discount lasts for one year from the date of approval. You are responsible for re-applying for a new sliding fee each year. If your sliding fee has expired, you will be responsible for 100% of the total cost of services.
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A household includes yourself, your spouse, any dependents under the age of 21, and anyone for whom you provide at least half of their living expenses and support.
The following is a list of people who are considered members of your household:
Yourself
Your legally married spouse, regardless of sex, even if they do not live with you*
Your dependent children, including adopted and foster children
Shared custody children, if you provide more than half of their support
Other relatives you are documented to provide more than half of their support
The following is a list of people who are not considered members of your household:
Unborn children
Legally separated or divorced spouse
Shared custody children, if you do not provide more than half of their support
Roommate
Unmarried domestic partner if you do not have children, or you do not claim the partner as a tax dependent
*You are not required to claim a spouse if you are the victim of domestic abuse, domestic violence, or spousal abandonment
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The sliding fee application must be fully completed and submitted to a Friends Clinic team member BEFORE your appointment. If approved, we will notify you of your payment amount. If your income changes, you are required to provide new income verification and it is possible your sliding fee will change.
You can download the application here and submit using the submission form below.
Looking to participate in our sliding fee scale program? Download the application here, fill it out, and resubmit your application using the form below. Your application is protected and will not be shared with any third parties. If you have any questions or issues, please contact our team by email at clinicalbilling@friendsforall.org or by calling or texting our clinic at 901-896-0739.