PEDIATRIC ASSOCIATES OF PIKEVILLE

Insurance Information

Sliding Fee Program

Healthcare for Everyone

As a National Health Service Corps site, Aaron Jonan Memorial Clinic promises to serve all patients. We do not deny services based on a person's race, color, sex, age, national origin, disability, religion, gender identity, sexual orientation, or inability to pay. Our clinic accepts insurance, including Medicaid, Medicare, and Children's Health Insurance Program (CHIP).

We offer discounted fees for patients who qualify. Our staff is available to assist you in determining your eligibility for a variety of health benefits coverage options. These options may include a sliding fee scale discount, special grant-provided services, or public-funded health care coverage. Eligibility is based on gross household income and family size. To determine eligibility, you (the patient) must bring ONE of the following items along with a completed Sliding Fee Discount Program Application:

current year's tax form (1040 form),
2 current pay stubs,
1 unemployment stub, or
letter from employer on letterhead that states your salary or wages.

If you have none of the above items available, you must provide a letter of reference from any 501(c)(3) (non-profit) organization on their letterhead (for example, your church). The patient/responsible party must complete the Sliding Fee Discount Program Application in its entirety.

The chart shows the percentage discounts available based upon NHSC guidelines for family size and income up to 200% of Federal poverty guidelines. Individuals or families earning at or below 100% of the Federal Poverty guidelines will incur a nominal fee of $40.00 per office visit for necessary medical treatment.

Num. of Persons in Household	Yearly Income	Monthly Income
1	$14,580.00	$1,215.00
2	$19,720.00	$1,644.00
3	$24,860.00	$2,072.00
4	$30,000.00	$2,500.00
5	$35,140.00	$2,928.00
6	$40,280.00	$3,357.00
7	$45,420.00	$3,785.00
8	$50,560.00	$4,213.00

2023 HHS Poverty Guidelines

Persons signing the Sliding Fee Discount Program Application authorize our clinic to confirm income as disclosed on the application form. Providing false information on the application will result in discounts being revoked and the full amount of the account being restored and payable immediately. If further information is needed for the application, our staff will contact the patient and will allow two weeks in which to provide this information to the clinic. After two weeks, the patient's application will be redated from the date the information is received. Any expenses incurred during this delay will be the responsibility of the patient. The discounted scale will not apply to these charges.