AFH offers a program that reduces fees charged to uninsured patients based on their income and family size. We base patient eligibility for this program on percentages of “Poverty Levels” determined annually by the federal government. Fees are determined either by a minimum fee or a percentage of the full charges. Insured patients may benefit from this plan as non-covered services may also be subject to a fee reduction.

Like every program, AFH has requirements. We acquire specific information from our patients prior to determining eligibility and establishing a sliding fee level based on the Federal Poverty Guideline Determinations are not made until the required documentation has been provided.

In order for you to qualify for our Sliding Fee Scale program, you must fill out an application and provide one (1) of the documents below.

• Pay stubs (most recent 4 weeks of income) or,
• Most recent Income Tax Return (attach Schedule C if self-employed) – Expires 04/15 of the  following year or,
• Workers  Compensation (most recent four weeks of income) or,
• Unemployment Compensation (most recent four weeks of income) or,
• Disability or SSI Benefits letter (permanent or temporary) or,
• Social Security Income or,
• Documents from local, state or Federal Agency or,
• Completed Employment Verification (for cash paid household members) or,
• Notarized letter of Support from family member (when none of the above is available) or a notarized letter stating you have no income or,
• Any type of documentation that serves the purpose as proof of income or financial status.

Determinations are not made until the required documentation has been provided.