SLIDING FEE DISCOUNT POLICY PROGRAM
Notice to Patients:
This practice serves all patients regardless of their ability to pay. Discounts for essential services are offered based on family size and income.
Below covers general points of the policy. If you would like to read the full policy click here
Blue Star Therapy, LLC and Shawnna Quesada, LCMFT Promise to:
Serve all patients
Offer discounted fees for patients who qualify
Not deny services based on a person’s:
Inability to pay
Accepted insurance includes:
1. Notification: BLUE STAR THERAPY, LLC. will notify clients of the Sliding Fee Discount Program
2. Request for discount: Requests for discounted services may be made by clients, family members, social services staff or others who are aware of existing financial hardship.
3. Administration: The Sliding Fee Discount Program procedure will be administered through the Therapy office.
4. Completion of Application: The patient/responsible party must complete the Sliding Fee Discount Program application in its entirety.
5. Eligibility: Discounts will be based on income and family size only. See full policy for eligibilty.
6. Income verification: Applicants may provide one of the following: prior year W-2, two most recent pay stubs, letter from employer, or Form 4506-T (if W-2 not filed).
7. Discounts: Those with incomes at or below 100% of poverty will receive a full 100% discount for health care services. Those with incomes above 100% of poverty, but at or below 200% of poverty, will be charged a nominal fee according to the attached sliding fee schedule. The sliding fee schedule will be updated during the first quarter of every calendar year with the latest Federal Poverty Line Guidelines.
8. Nominal Fee: Clients with incomes above 100% of poverty, but at or below 200% poverty will be charged a nominal fee according to the attached sliding fee schedule and based on their family size and income.
9. Waiving of Charges: In certain situations, clients may not be able to pay the nominal or discount fee. Waiving of charges must be approved by BLUE STAR THERAPY, LLC.’s designated official. Any waiving of charges should be documented in the client’s file along with an explanation.
10. Applicant Notification: The Sliding Fee Discount Program determination will be provided to the applicant(s) in writing, and will include the percentage of Sliding Fee Discount Program write off, or, if applicable, the reason for denial.
11. Refusal to Pay: If the client does not make effort to pay or fails to respond within 60 days, this constitutes refusal to pay. At this point in time, BLUE STAR THERAPY, LLC. can explore options not limited to, but including offering the Client a payment plan, waiving of charges, or referring the client to collections.
12. Record Keeping: Information related to Sliding Fee Discount Program decisions will be maintained and preserved in a centralized confidential file located in the Therapy Office, in an effort to preserve the dignity of those receiving free or discounted care.
13. Policy and Procedure Review: The Sliding Fee Schedule will be updated based on the current Federal Poverty Guidelines.
14. Budget: During the annual budget process, an estimated amount of Sliding Fee Discount Program service will be placed into the budget as a deduction from revenue.