Care shouldn't wait on what's in your wallet

All clients seeking outpatient services are assured that they will be served regardless of their ability to pay. No one will be refused service due to a lack of financial means, as long as they complete and are found eligible in the application process.

Requests for discounted services may be made by clients, family members, social services staff, or others aware of existing financial hardship. Discounted services apply effective the date of application approval going forward.

The Sliding Fee Discount Program is administered through the assigned service provider. Information about the policy and procedure will be provided, and assistance offered after the completion of the application. Dignity and confidentiality are respected for all who seek and/or are provided discounted care.

All alternative payment resources must be exhausted, including all third-party payments from insurance, federal, and state programs.

The client/responsible party must complete the Sliding Fee Discount Program application in its entirety. By signing the application, persons authorize Kindred Connections Counseling PLLC / ECCG access to confirm the income disclosed on the form. Providing false information will result in the revocation of all discounts.

Initial Application: If an application cannot be processed due to the need for additional information, the applicant has two weeks from the date of notification to supply the information without having the application date adjusted. If requested information is not provided promptly, the application date will be revised to the submission date.

Renewal Applications: A client receiving discounted services under this policy must submit an updated application every three months or when their financial situation changes. Failure to meet this requirement may result in ineligibility for the program. If delinquent in submitting renewal information, a notice will be sent, and the client will have 10 business days to respond.

Discounts are based on income and family size only. A family is defined as the head of household, spouse, and dependent children.

Earnings, unemployment compensation, worker's compensation, Social Security, Supplemental Security Income, public assistance, veterans' benefits, survivor benefits, pension/retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources. Non-cash benefits (such as food stamps and housing subsidies) do not count.

Applicants must provide: prior year W-2 (if applicable) and the two most recent pay stubs. You may be asked to provide two months of bank statements to verify income further if needed. Self-employed individuals must submit details of the most recent three months of income and expenses for their business. Self-declaration of income may be used in special circumstances (e.g., homelessness).

The sliding fee schedule is updated during the first quarter of each calendar year with the latest federal poverty guidelines.

The determination for the Sliding Fee Discount Program will be provided to the applicant(s) in writing, including the percentage of the discount or the reason for denial. If approved for less than 100% or denied, payment arrangements must be established immediately. The applicant may reapply after three months or upon significant change in family income.

If a client verbally expresses an unwillingness to pay or leaves without paying, they will be contacted in writing regarding their payment obligations. If not on the sliding fee schedule, a copy of the application will be included with the notice. Failure to respond within 60 days will constitute refusal to pay, and the practice may explore options such as payment plans, waiving charges, or referring to collections.

Information related to Sliding Fee Discount Program decisions is maintained within our HIPAA-compliant Electronic Health Record System (EHRS) to preserve the dignity of those receiving free or discounted care.