Sliding Fee Schedule Program
We are committed to providing quality healthcare to the patients we serve regardless of their ability to pay. A sliding fee scale based on guidelines in the Federal Registry is used at each facility and updated annually.
Any patient may apply for the fee adjustments based on their income and the size of their family.
The sliding fee scale does NOT apply to:
- Lab work (Labs sent out of Mostellar Medical Center or Southwest Alabama Health Services Labs) Note: The patient is responsible for paying discounted Lab Corporation Fee plus office visit at time of service.
- Hospital charges
- Depo-Provera (birth control)
- Sports Physicals
- Motor Vehicle Accident cases
- Workman's Compensation cases
- DOT Physicals
- Skin Tests
The sliding fee scale cannot be used for charges payable to Medicare, Medicaid, private insurance or any third party payers. However, the sliding fee schedule adjustments may pay for services not covered by insurance carriers.
To apply for this service, each patient is required to complete an Application. (Applications are offered in English, Spanish and Vietnamese under our Forms page. For other languages, please inform the staff of your needs)
All verification information must be from patient or head of household.
- Submit one month of the most recent payroll check stub; or statement from current employer; or proof of any other income received (child support, SSI, alimony, etc.); W-2 forms are accepted
- Submit three (3) letters from non-related persons verifying that patient is not employed.
If proof of income is not submitted in person within 30 days of initial application, the patient may be removed from the Sliding Fee Schedule Program.
The Sliding Fee Schedule Program application must be renewed annually. Changes in family income must be reported to the Sliding Fee Schedule Program clerk or receptionist.