Sliding Fee Scale

Payment Options

Gulf Coast Health Center accepts cash, check, Visa, MasterCard, or Discover, most forms of insurance, Medicare, and Medicaid.

For people without insurance we base our charges on a sliding fee scale. For people with insurance we will slide your co-payment. Proof of one month’s worth of income is required to determine the fees for services rendered.

Fee Calculator

Enter your household size and income information  Your Sliding Fee Level
 Number of household members:
 Total amount of household income:
Is the income monthly or yearly?
Monthly:
Yearly:
Push “SUBMIT” to get results:

The sliding fee scale is based on the Federal Poverty Guidelines. Visit: http://aspe.hhs.gov/POVERTY/ for more information.The cost above is only an estimate based on our guidelines. These rates are subject to change.

Sliding Fee Scale Requirements

To qualify for a potential discount the patient must furnish proof of household income. The following types of proof will be be acceptable:

We offer patients levels of eligibility:

ELEVEN (11) MONTH ELIGIBILITY PERIOD (any one of the below)

  1. Current year income tax return (complete 1040 and all schedules)
  2. Social security award letter
  3. Copy of most  recent check received from social security or retirement
  4. W2 from recent year

THREE (3) MONTH ELIGIBILITY PERIOD (any one of the below)

  1. A notarized letter of support with the person signing furnishing current income information
  2. Patient’s food  stamp eligibility letter with dollar amount
  3. Notarized letter of cash payments from patient’s employer
  4. Current unemployment statement or check stub
  5. Copies of child support checks
  6. Most recent check stubs for a complete month

ONE (1) MONTH ELIGIBILITY PERIOD (any one of the below)

  1. Most recent check stub
  2. Copy of most recent bank statement showing direct deposits

Proof of household income is required for a sliding fee scale discount. A patient may be seen at full cost and no proof of income is required. We also accept Medicaid, Medicare, CHIPS, and private insurance without income requirements.

Frequently Asked Questions

What is the Sliding Fee?

Sliding fee is used to calculate the fee uninsured patients are responsible for upon receiving services. The fee amount is calculated using patient gross household income and family size.

What is the Gulf Coast Health Center’s sliding fee based on?

Gulf Coast Health Center’s sliding fee is based on the federal poverty guidelines and is subject to change.

What if my household is bigger than 10 members?

If your household consist of more than 10 people you need to schedule an appointment with a Gulf Coast Health Center Case Worker to calculate the fee that would apply to you. To schedule an appointment please call 409.983.1161.

How can I calculate the fee if I need to see a dentist?

Depending on the nature of you dentist visit there may be other fee’s you would be responsible for. Therefore, to calculate your fee for a dental visit, you need to schedule an appointment with the Gulf Coast Health Center.

When is the fee due?

The fee is due at the time of visit. If you are unable to pay your bill at the time of the visit, you will need to meet with a financial counselor.