Financial Hardship Program
Sliding Fee
Discount Program
1
What is our Financial Hardhsip Program ?
This program is available on a limited basis, subject to availability. Slots are capped monthly. Completing an application does not guarantee a discounted appointment or a reserved spot.
2
How discounts are calculated?
Your discount is based on where your household income falls relative to the Federal Poverty Guidelines (FPG) - income thresholds set annually by the federal government based on household size. You can look up current FPG levels at hhs.gov
Discounts apply to psychiatric medication management visits only. A minimum fee applies at all income levels - no visit is provided at $0.
Approval is valid for six (6) months. Reapplication with updated income documentatio is required at renewal.
3
How to apply
-
Complete the application in the next column
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Upload one income document: most recent tax return, two recent pay studs, Social Security award letter, disability benefit statement, or employer letter.
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Our billing team will confirm whether a slot is available and contact you within 3 to 5 business days.
-
If approved, you will receive a Sliding Scale Consent Agreement to sign before your first visit.
5
Capacity Limit Notice
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This program has a limited number of spots available each month. Completing this application does not reserve a spot or guarantee approval. Our billing team will review your application and contact you within 3 to 5 business days to confirm whether a slot is currently available. If no spots are open, you will be added to our waitlist. In the meantime, ask about our Membership Program starting at $89/month.
6
Insurance Exclusion
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This program is for uninsured patients only - adults and adolescents who are not currently enrolled in any health insurance plan. You are NOT eligible for this program if you have: Medicaid (SoonerCare), Medicare, CHP, marketplace/ACA coverage, employer-sponsor insurance, or any other active health insurance. If you recently lost coverage, you may apply. If you are unsure whether you qualify, contact our billing team at 405-914-6634 before applying.
We beleive psychiatric care should be accessible. Our financial hardship program offers reduced-fee psychiatric medication management appointments to a limited number of uninsured patients each month, based on household income.
This program is available on a limited basis, subject to availability. Slots are capped monthly. Completing an application does not guarantee a discounted appointment or a reserved spot.
Patient Consent & Agreement
1
What is our Financial Hardhsip Program ?
This program is available on a limited basis, subject to availability. Slots are capped monthly. Completing an application does not guarantee a discounted appointment or a reserved spot.
2
How discounts are calculated?
Your discount is based on where your household income falls relative to the Federal Poverty Guidelines (FPG) - income thresholds set annually by the federal government based on household size. You can look up current FPG levels at hhs.gov
Discounts apply to psychiatric medication management visits only. A minimum fee applies at all income levels - no visit is provided at $0.
Approval is valid for six (6) months. Reapplication with updated income documentatio is required at renewal.
3
How to apply
-
Complete the application in the next column
-
Upload one income document: most recent tax return, two recent pay studs, Social Security award letter, disability benefit statement, or employer letter.
-
Our billing team will confirm whether a slot is available and contact you within 3 to 5 business days.
-
If approved, you will receive a Sliding Scale Consent Agreement to sign before your first visit.
5
Capacity Limit Notice
-
This program has a limited number of spots available each month. Completing this application does not reserve a spot or guarantee approval. Our billing team will review your application and contact you within 3 to 5 business days to confirm whether a slot is currently available. If no spots are open, you will be added to our waitlist. In the meantime, ask about our Membership Program starting at $89/month.
6
Insurance Exclusion
-
This program is for uninsured patients only - adults and adolescents who are not currently enrolled in any health insurance plan. You are NOT eligible for this program if you have: Medicaid (SoonerCare), Medicare, CHP, marketplace/ACA coverage, employer-sponsor insurance, or any other active health insurance. If you recently lost coverage, you may apply. If you are unsure whether you qualify, contact our billing team at 405-914-6634 before applying.