Sliding Fee Discount Program

No insurance? We can help!

Whether or not you have insurance, CHC may be able to reduce your costs through our Sliding Fee Discount Program. All patients are encouraged to complete an application. Eligibility is based on a person’s income and the number of people in their household.

All services provided by outside specialists, labs, or radiology are not covered and you will be responsible for any and all charges.

To apply for the Sliding Fee Discount Program, you must:

1. Fill out CHC’s Sliding Fee Discount Program Application:

2. Give CHC proof of your estimated current monthly or annual income:

- - Pay stubs, recent tax return, unemployment statements, SSI letter, child support statements, letter from employer, L&I award letter, bank statement
    OR
  - Signed self-declaration of no income

Sliding Fee Discount Eligibility Guidelines

Follow these steps to determine patient responsibility or the level of discount available in the table below:

Find the size of your family in the left-hand column
On the row of family size, find your household’s annual income
Once you’ve located your income level, go to the top of the column to find the patient responsibility or level of discount (A-F).
For Medical, Dental, or Behavioral Health services, please refer to the tables below for pricing estimates.
Full payment of your portion is due at the time of service.