Do You Qualify For a Discounted Rate?

Azalea Health is a Federally Qualified Health Center (FQHC) and receives some federal funding to help offset the cost of providing our quality health care services to patients on a sliding fee scale. Eligibility for the sliding fee discount is determined by documented annual income and family/household size. Patients with a documented annual income of 200% or below the federal poverty level (FPL) are eligible for a sliding fee discount on all Azalea Health services, including prescriptions written by an Azalea Health provider and filled at an Azalea Health pharmacy.

Patients with incomes at or below 100% of the federal poverty level (FPL) are charged a nominal fee; however, no patient will be refused services due an to inability to pay. Patients unable to pay the discounted fee at the time of service will be required to sign a payment plan agreement.

Determining your eligibility for the sliding fee discount requires verification of your income. This information must be updated at least annually to continue your participation in the program. This information is only used to calculate your discount and is kept completely confidential.

Documentation Required for Sliding Fee Application

1. You MUST Provide ONE of the Following Items

  • Pay Stubs (Your household’s pay stubs for the most recent four (4) weeks.)
  • Employer Letter Verifying Employment (Only if paid in cash.)
  • Unemployment Benefit Summary Letter (Only if collecting unemployment.)
  • If You Have No Income: Provide a notarized letter from a person you know (not related to you) verifying you have no income and stating your living arrangements such as food and shelter.

2. Proof of Identity

This can be a Government-issued ID card, Current Driver’s License from any state, School ID, Birth Certificate or Passport.

3. Proof of Residency

This can be in the form of a utility bill, lease/mortgage, legal correspondence mailed to you in your name or your spouse’s name.

4. Financial Documents

A copy of your recent tax records or bank statements may be requested.

5. Other

Other items that may be requested if available are: Veterans, Social Security or Pension Benefits documentation, Child Support/Alimony verification, Workman’s Comp verification