Central Ozarks Medical Center

The Sliding Fee Discount Program

All patients under 19 years of age must have a Medicaid denial letter to be eligible for the Discount Program.

Household Size:

• Household size includes all people living in your home EXCEPT for those you are not financially responsible for.
• Marital Status is not a factor when determining household size.

Household Income

• Household income includes ALL INCOME earned by ALL INDIVIDUALS COUNTED IN HOUSEHOLD SIZE.

Acceptable Forms of Proof of Income

• Prior year’s tax return
• Paycheck Stubs
• Letter from employer showing Year-to-Date wages and dates of employment
• Letter from Social Security, Veteran’s Affairs, Employment Office, etc.
• Other proof of income may be accepted and will be determined on an individual basis

**Countable incomes are outlined below**

Insurance and Sliding Fee Discount Program
Under-insured individuals are still eligible for the sliding fee discount program. Provide your insurance card at the time you complete your application so a determination of the discount can be determined.  Insurance will be billed first, then you will be given the discount you are eligible for after the claim has been processed.

Encounters Types
Dependent upon household income and household size the applicant will be assigned a flat fee level.  Clinic based medical encounters, behavioral health encounters and Tier I dental encounters are all covered at the flat-fee the patient is eligible for based on the sliding fee discount scale.

Charges for Tier II dental procedures will be billed at a percentage of our normal fees and will be added to any Tier I charges for that visit.
Hospital Care –  If you are an existing COMC patient participating in the Sliding Fee Discount Program and are admitted to the hospital by a COMC physician, the following Physician services are eligible for the Discount Program.

• Hospital Admission
• Hospital Follow-up
• Hospital Discharge

Other Services NOT Covered by the Sliding Fee Discount Program are as follows:

• Services related to motor vehicle accident and work comp services
• Lab/x-ray ordered by providers outside COMC
• Elective/Cosmetic Procedures to include, but not limited to:
• Circumcision
• Removal of moles/skin tags (for cosmetic purposes)
• Certain Dental Procedures
• Piercings
• Any supply related to contraception
• Medical Weight Loss Program (SSHC)
• Exam and lab work required for Boxing
• Elective Dental Procedures
• Bridge
• Temporary Dentures
• Porcelain Crowns

The Sliding Fee Discount Program is retroactive for 30 days.  All applications must be completed in FULL.  Applications cannot be accepted without proper proof of income. Central Ozarks Medical Center is pleased to help meet your healthcare needs.  We invite you to share this Discount Program information with others.  If you have questions about this program, please speak to an Access Coordination at the reception desk.

Countable Income Includes:

1. 1040 Federal Tax Form (Adjusted Gross Income is used from this document)
2. 2-3 Consecutive Pay Stubs (Use total wages earned)
3. Social Security Benefits (Benefit Letter – Total Award Amount)
4. Unemployment Benefits
5. Alimony
6. Retirement Benefits (including Military Retirement)

No-Countable Incomes Includes:

1. TANF or Food Stamps
2. Social Security Income (SSI)
3. Child Support
4. Veterans Benefits (VA Benefits)
5. Veterans Disability (VA Disability)
6. Workers Compensation Payments
7. Federal Tax Credits
8. Scholarships/Awards used for education
9. Income of a child under 19 who is not required to file taxes as his or her income is less than the Federal Tax Filing Threshold.