Eligibility


Who Can Receive Our Services:


Eligible Zip Codes for:

Adams County (These include the following townships: Huntington, Latimore, Menallen, and Tyrone):

17304 17372 17306 17324 17337

Cumberland/Franklin County (These include the following townships: Cooke, Dickinson, Hopewell, Lower Frankford, Lower Mifflin, Middlesex, Monroe, North Middleton, North Newton, Penn, Southampton, South Middleton, Upper Frankford, Upper Mifflin, and West Pennsboro):

17007 17241 17013 17015 17257 17240
17065 17266 17081 17324 17081

Perry County (These include the following townships: Carroll, Centre, Jackson, N.E. Madison {Sandy Hill}, Saville, S.W. Madison, Spring, Toboyne, and Tyrone):

17006 17047 17024 17068 17031 17071
17037 17090 17040

** Uninsured and underinsured patients may qualify for Reduced Fee Discount if they reside in our service area. Proof of total household income and Reduced Fee Application is required, to be renewed annually. Based on the information provided a discount may apply for each visit.


Reduced Fee Application Policy/Procedure

Download the Reduced Fee Application

I. POLICY

Effective August 1, 2011, all patients participating in the reduced fee program will be required to meet with the Intake Specialist to discuss the program, its requirements and possibly complete an application for Medical Assistance or CHIP coverage.

II. PURPOSE

The purpose of this procedure is to outline and clarify the information required on the Reduced Fee Applications, as well as the information required to process the reduced fee application. Sadler Health Center Corporation is a nonprofit community health center. We receive money from many different sources so that we can provide medical and dental care to qualified individuals for a reduced fee based on family size and income. In order to determine if a patient qualifies to receive a reduction of the bill, information is needed and patients must provide proof of household income. This information is required to be updated annually or whenever family income or family situation changes, or whenever requested by Sadler Health Center.

III. PROCEDURES

All reduced fee applications will be reviewed and processed by the Intake Specialist. The Intake Specialist will review the application for its completeness and accuracy. The following information MUST be completed on each Reduced Fee Application received:

In the event any of the above information is not completed, the application will be returned to the patient for completion and the patient will not be eligible for any further discount until the application is completed.

In addition, the proof of income MUST be included with the submission of the Reduced Fee Application. The Intake Specialist will ensure that proof of household income is attached. The following are acceptable types of income proof:

All patients applying for participation in the Reduced Fee Program will be screened for Medical Assistance eligibility. Patients will meet with the Intake Specialist and the Intake Screening form (attached) will be completed to determine their eligibility to apply for Medical Assistance coverage. If a patient meets eligibility criteria, the Intake Specialist will pursue the Medical Assistance application with the patient. If the patient does not meet the eligibility requirements, the Reduced Fee Application will be processed and the information input into the practice management system. The completed Intake Screening form will be attached to all Reduced Fee Applications for accurate record keeping and the information will be input into the appropriate tracking spreadsheet.

In the event a patient is determined by the Intake Specialist to be eligible to proceed with the medical assistance application process, and the patient fails to complete the medical assistance application, the patient will not be eligible to participate in the Reduced Fee Program and will be required to pay full fee with patient being due at the time of service.

If applying for government assistance is against a person's religious belief, participation in the Reduced Fee Program will be based on the verifiable reported income.

THE MOST CURRENT INFORMATION WILL BE USED TO DETERMINE THE FEE DISCOUNT (previous discounts will not be honored if current information is available to determine the eligibility. For example, if a patient has an expired reduced fee application on file and they bring in new/current information, the new/current information is to be used to determine the eligibility for a reduced fee. Patients who refuse to provide the above information will not be eligible for participation in the Reduced Fee Program and will be required to pay full-fee at the time of service. By signing/submitting a Reduced Fee Application, it is understood that any and all information provided can and will be verified by Sadler Health Center. Furthermore, it is understood that providing incomplete or false information could result in a patient's dismissal from Sadler Health center, as well as notification to other government agencies from which the patient received benefits, including but not limited to: Pennsylvania Medical Assistance, Cumberland County Housing Authority, and Cumberland County Public Assistance Office.

All information will be confidential and will only be used in connection with enrollment into the Reduced Fee Program.

Formulas for calculating monthly income:

Weekly pay check…gross income multiplied by 52 weeks in a year divided by 12=monthly income.
   Example (225.00 x 52= 11,700/12=975.00)

Bi-weekly pay check…gross income multiplied by 26 weeks in a year divided by 12= monthly income.
   Example (450.00 x 26= 11,700/12=975.00)

Semi-monthly pay check…gross income multiplied by 24 weeks in a year divided by 12=monthly income.
   Example (487.50 x 24= 11,700/12=975.00)

Income tax return…adjusted gross income divided by 12=monthly income.
   Example (11,700.00/12=975.00)

The Intake Specialist will determine the discount rate if applicable and will enter all pertinent information into the practice management system, as well as complete the appropriate section(s) on the Reduced Fee Application form.

All Reduced Fee Applications will be reviewed annually. Renewal reminders will be sent via US Mail to patients during the month prior to the Reduced Fee Application expiration date.

The Intake Specialist will then forward ALL Reduced Fee Applications to the Billing Manager for review and co-signature. All Reduced Fee Applications will be reviewed for accuracy and completeness. This will be done on a daily basis.

In the absence of the Billing Manager, her designee may review and co-sign the Reduced Fee Applications.

IV. SCOPE & RESPONSIBILITIES

It is the responsibility of the Billing Manager to oversee and manage this policy and procedure. The Billing Manager and the Director of Financial Services will review this policy and procedure on an annual basis and recommend any changes to the Finance Committee and Board of Trustees for approval.