Sliding Fee Scale Notice

 

Discounted/Sliding Fee Application

It is the policy of Palouse Medical to provide essential services regardless of the patient’s ability to pay. Discounts are offered based upon family income and size.

Please request an application, complete all the required information, and return the completed forms to the office. Palouse Medical will then process your documentation and review the information provided to determine if you, or members of your family, are eligible for a discount.

If approved, the discount will apply to all services received at this clinic, but not those services which are purchased from outside our clinic. Some of the services that will not be covered include: reference laboratory testing, drugs, x-ray interpretation by a consulting radiologist, and other such services.

In the hope that your financial situation improves, discounts apply only to current, not future services. Additionally, this form must be completed every 6 months. Please inquire at the front desk or ask to speak with a representative of our billing office if you have further questions.

Thank you!