Sliding Fees &
Good Faith Estimates

A Federally Qualified Health Center receives federal grant funding plus accelerated Medicare and Medicaid reimbursement for providing Behavioral Health, Dental, and Medical services to patients despite their ability to pay. To determine a patient’s ability to pay NEWCC is required to offer a Sliding Fee Discount Program.

The sliding fee discount program is a federal program that allows NEWCC to discount our normal charges for health care services we provide. The Sliding fee Discount Program is available to all patients regardless of immigration or insurance status. NEWCC will never deny health care based on the patients’ ability to pay. Discounts are based on family size and income as verified on the date of the first visit and then annually. The discount from sliding fee discount program can only be used at NEWCC clinic locations.

Please fully complete and return the sliding fee application with the proof of income that reflects your current household status. We urge you to complete this application at your earliest convenience to determine your ability to pay.

Anyone is welcome to apply for the Sliding Fee Discount Program. All patients without insurance MUST be evaluated for the Sliding Fee Discount Program. If you refuse to be evaluated and supply the required documentation, you cannot receive a discount under the Sliding Fee Scale.

Approval for the program is based on family size and combined household income in accordance with the Federal Poverty Guidelines.

If you are eligible for other assistance programs such as Medicaid, we will assist you in applying for these programs in addition to the Sliding Fee Discount Program.

Eligibility is based on the family size and combined household income. You must show proof of income from the last 30 days for all family members living in your household. If you do not provide proof of income or you do not qualify based on your income and family size, you will have to pay the full charges for your services.

You will need to bring in proof of income (a 30 day period in the last 3 months) for all family members living in the household. You will also need to fill out the “Sliding Fee Discount Program Application.”

The following documents are acceptable to bring for evaluation of the sliding fee. This is needed for all members of a household (not including roommates/non-family members) and will be used to figure how much of a discount you will receive.

• Prior year income tax return or W-2
• Check stubs from the 4 weekly or 2 biweekly pay periods preceding the application.
• Un-employment check(s)
• Social Security (SSI) checks or statements
• Pension checks
• Alimony, child support, etc.
• Verification of income by employer
• Bank statements to verify any direct deposits.

Family/Household Size: is the number of people in a household related by birth, marriage, or adoption who live together and share responsibility for income, food, and/or housing expenses. A household can also include individuals who live together not related by birth, marriage, or adoption, if the household guarantor has financial responsibility for that individual. A household may consist of a single person.

The sliding fee is active for 1 year from the approval date. You must re-apply prior to expiration date in order to continue being covered under the Sliding Fee Discount Program. If you do not re-apply before your expiration date, you may have to pay any charges for services that happened during that period after the expiration date until you re-enroll.

The sliding fee scale applies only to those services provided directly by or controlled by NEWCC. Services provided under referral are NOT covered by the NEWCC Sliding Fee Program.

Some examples of services that are covered are: medical visits, dental visits, behavioral health visits, alcohol, and other drug abuse (AODA) services, and physical therapy.

No. Eligibility for the Sliding Fee Discount Program is based on your income and family size. If you choose not to provide NEWCC with this information, you will be responsible for the total charges of services rendered.

You must apply every year. You may re-apply sooner than one year if there is a change in your current household size or income.

The charge for your visit depends on your income, family size, and the type of service you received. When you are approved for the Sliding Fee Discount Program you will pay according to your percent of income in relation to the federal poverty level. Payments are due at the time of service.

If you have any questions or need assistance completing the application, please contact a member of our Health benefits team call (920) 863-9376 or by email HBS@newcc.health. They will help you explore other options to assist you in paying your balance. A hardship waiver is available for a 6-month period pending approval. NEWCC will never deny health care due to a patient’s inability to pay for the services.