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Sliding Fee Scale Policy & Application

It is the policy of G&G Healthcare, P.C. to provide essential services regardless of the patient’s ability to pay. G&G offers discounts based on family size and annual income. Patient eligibility for the program is decided by these factors. Sliding fee rates are based on the Federal Poverty Guidelines. This site policy and Sliding Fee Schedule program applies to all G&G Healthcare patients. 

The Sliding Fee Schedule will be advertised on office bulletin boards, in patient waiting areas, exam rooms, company website, and social media pages. 

To participate, the patient must complete the Sliding Fee Discount Application and return it to the practice to determine if they, or members of their family, are eligible for a discount. The patient must provide proof of income to the practice in the form of tax returns, pay stubs, or other information verifying income before a discount is approved.  

The discount will apply to all services received at this clinic, but not those services or equipment purchased from outside, including reference laboratory testing, drugs, and x-ray interpretation by a consulting radiologist, and other such services. The patient must complete the application every 12 months or if their financial situation changes. 

A nominal fee of $5, less than the fee paid by a patient in the first sliding fee discount pay class above 100% of the Federal Poverty Guideline, will be collected for services. Patients who qualify for the program will not be sent to collections for outstanding debt. 

Your application will only be processed after all information is provided, including proof of income. Most applications are processed within 2 weeks of submission, and you will be notified of the determination. You must complete this form every 12 months or if your financial situation changes. Click the button below to submit an application.

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