Payment Options
Private Insurance
You will be responsible for your co-pay and we will bill your insurance. If financially eligible, the co-pay will be adjusted to sliding scale based on your ability to pay.
Medicaid, Medicare, GNOCHC
We will bill your insurance program and/or help you enroll in these programs. You will be billed for any uncovered costs and may pay your balance at the clinic. Medicaid and GNOCHC enrollment/verification are available on site.
Uninsured / Self-Pay
Uninsured patients may qualify for a discount depending on household size and income. In order to qualify, you must provide proof of income (see page 4). The minimum payment for a visit is $30 and is due at the time of visit.
Current Federal Requirements
Federal requirements dictate that we must charge all patients the same according to the length and complexity of the visit. If you have insurance, i.e. Medicare, Medicaid, GNOCHC, or commercial insurance, you out-of-pocket expenses are defined by the policy.
For Medicaid: No co-payment on __ of the patient.
For GNOCHC: No co-payment.
Note each time you register, we will check to see if you are eligible for either of these and assist in enrollment if eligible.
For private/commercial insurance: Co-payment at time of visit, determined by insurance plan. If financially eligible, i.e. less than or equal to 200% of the Federal Poverty level, a sliding scale fee stucture is available.
For uninsured/private pay: Patients are charged according to a sliding scale fee structure based on a percentage of the federal poverty level.
As the graph below shows, household incomes eligible for specific sliding scale medications increase with increased members of the family.
For uninsured individuals wih household incomes greater than 200% the Federal Povery Level, fees will be full cost of the visit. According to present guidelines, the full cost of an outpatient visit will usually range between $107 to $237 per visit.
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FAMILY SIZE |
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1 |
< or = $11,170 |
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> or = $22,340 |
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2 |
< or = $15,130 |
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> or = $30,260 |
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3 |
< or = $19,090 |
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> or = $38,180 |
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4 |
< or = $23,050 |
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> or = $46,100 |
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5 |
< or = $27,010 |
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> or = $54,020 |
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6 |
< or = $30,970 |
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> or = $61,940 |
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7 |
< or = $34,930 |
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> or = $69,860 |
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8 |
< or = $38,890 |
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> or = $77,780 |
GNOCHC Eligibility
Individuals Eligible for GNOCHC are Those Who:
- Have been uninsured for at least 6 months;
- Are not pregnant;
- Are between 19 and 64 years old;
- Are not eligible for basic Medicaid, CHIP, or Medicare;
- Are residents of Jefferson, Orleans, Plaquemines, or St. Bernard Parish;
- Whose family income up to 200% of the Federal Poverty Level; and
- Meet the U.S. citizenship requirements under the Deficit Reduction Act (DRA) and Children’s Health Insurance Program Reauthorization Act (CHIPRA).
GNOCHC Benefits are Limited to These Services:
- Care Coordination
- Certain Immunizations and vaccines
- Certain Laboratory and radiology
- Behavioral health services
- Primary care
- Preventative care
- Substance abuse referral services
- Specialty care (covered with referral from Primary
New Patients with Medicaid
If you are a new patient with Medicaid at the time of your visit, we will verify that you are linked to us and assist in ____ if necessary.
We are required to obtain current and accurate financial information in order to see if you are eligible for any insurance program or for the sliding scale reduction of charges.
The process now requires that we have current financial information. If you have NOT presented us with complete financial information within the last 3 months please bring the following information. We must have current and complete financial information before we can schedule return appointments.