Uninsured or Underinsured?
Apply for the Adjustable Payment Plan!
The Adjustable Payment Plan (APP) is available to any patient utilizing our family of clinics. Patients that are uninsured, underinsured, and/or have been denied health insurance and whose income is at or below the 200% of the current Federal Poverty Guidelines may qualify for this program. Eligibility for this plan is based on gross family income (all working members within the household) and household size (all members in the family).
“You can see a medical provider and receive healthcare services at a reduced cost (based on your household’s income and size).”
What to expect?
Gather your household information
(1) Your Gross Household Income: current 2 pay stubs, SSI, Recent Taxes, etc. for every member of your household. Read more below “What is Household Income?”.
(2) Your Photo ID
(3) Your Insurance Information and Card (if applicable)
Complete and submit your application
You can download and complete our Adjustable Payment Plan Application ahead of time or complete the application in our office.
You will submit your completed application at any of our health center locations. Please make sure to bring the household information items referenced above in step 1.
Your payments will be adjusted on a sliding fee scale. Medical visits begin at $35 for those that qualify. Dental visits, chiropractic visits, pharmacy, etc. have different nominal/minimal fees. These will be covered with you after establishing your eligibility.
What is household income?
Income includes any of the following for each member of the household: earnings, unemployment compensation, workers’ compensation, Social Security, Supplemental Security Income, public assistance, veterans’ payment, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources. Noncash benefits (such as food stamps and housing subsidies) do not count.
What is family size?
Family is defined as: a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family.
A Family is further defined as anyone receiving more than 50% of their support from a head of household, whether living within the same household or not. Students must produce income proof from family members providing more than 50% of their support, and grants for attending school.
Using the Adjustable Payment Plan (APP)
The Adjustable Payment Plan will reduce your patient financial responsibility and help you save on healthcare costs.
For example: Ann receives several services that total $500. Ann is uninsured and has qualified and applied for the Adjustable Payment Plan. Her total patient responsibility is adjusted and reduced to a total of $35.
All patients that have no insurance or are underinsured are encouraged to apply. Patients may qualify if their household income is at or below 200% of the Federal Government’s Poverty
Once qualified/approved, the individual will remain qualified for a period of 1 year, unless a change in family size or family income is reported that will change the APP category or eligibility for the adjustment/discount. Eligibility will be reevaluated annually.
You can apply during regular business hours at any of our health centers. See our health center locations.
To apply you must complete the Adjustable Payment Plan application and provide the requested documentation. This information will be used to establish your eligibility for the program. For those that qualify, our staff will review your financial responsibility and benefits with you.
Households that are living at or below 200% of the Federal Poverty Guidelines will fall into one of the categories below (A-E). Each category has a different nominal fee or minimal fee per visit. Pharmacy, Chiropractic Services, and Dental Services have different fees. After establishing eligibility, our registration specialist will review your financial responsibility in full.
Medical Sliding Fee Scale
*Please note that your level of adjustment will be based on the Federal Poverty Guidelines as published every year by the U.S Department of Health and Human Services and that your total patient responsibility may be greater than your minimal fee
For those patients that choose not to provide information required by CNAHSI to determine family size and income, even after being informed that they may qualify for adjustments/discounts, are viewed as declining eligibility for APP. CNAHSI will consider these patients to be ineligible for such discounts.
Patients declaring no job and/or no income, on the application, will be required to sign a Self-Declaration Form, and will be placed on the program for 30 days. Patients who have self-declared will need to verify at each visit that they continue to be unemployed or have no income, and must re-sign the self-declaration form. Self-declared patients must provide information about resources available to them for shelter, food, clothing, and other living needs.
The Federal Poverty Guidelines are issued each year in the Federal Register by the Department of Health and Human Services (HHS). They are used to determine financial eligibility for many federal programs.
All services within CNAHSI’s approved scope of project for which CNAHSI charges patients is offered on the APP.
Any member of the household listed on the application as a dependent may be eligible for the Program (eligible family members must also be uninsured/ underinsured).
Please bring proof of:
(1) Your Gross Household Income: current 2 pay stubs, SSI, Recent Taxes, etc. for every member of your household.
(2) Your Photo ID
If you are having issues with demonstrating proof, please call your local health center and ask to talk to a Registration Specialist.
(3) Insurance information (if applicable)
Still have questions? Call our Registration Specialist at 256-533-6311 ext. 2525
Will I qualify for the Adjustable Payment Plan?
You can now use our quick online calculator to see if you will qualify for the Adjustable Payment Plan. Certain individuals may qualify at different levels.