Payment Options & Information

Good Faith Estimate

You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost. A Good Faith Estimate is the total expected cost of any non-emergency health care items or services and includes related costs (e.g., medical and laboratory tests, prescription drugs, and equipment).

Under the law, health care providers need to give patients who do not have health insurance or who are not using health insurance an estimate of their bill for health care items and services before those items or services are provided. For appointments scheduled three days in advance, patients will receive a Good Faith Estimate in writing at least one business day before your medical service or item.

If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.

Make sure you save a copy or picture of your Good Faith Estimate.

Good Faith Estimates are available to all patients upon request.


Sliding Fee Discount Program

The Sliding Fee Discount Program allows us to reduce or “slide” the fees for the care (Medical, Behavioral Health, and Dentistry) you or your family receive at United Family Medicine.

If your income is low, you can receive the quality health care you need at our clinic. We can help you with our Sliding Fee Discount Program.

This Program is available to all patients of United Family Medicine who qualify. To see if you qualify, we will consider the size of your family and your income. We will then determine your discount based on a discount schedule of federal poverty income guidelines.

 2023 Sliding Fee Visit Charges

Discount Level
Visit Type A B C D E
Lab Only / Immunization No Charge $5 $10 $15 Full Charge
Medical / Behavioral Health $25 $40 $55 $70 Full Charge
Dental – Simple $10 $20 $25 $30 Full Charge
Dental – Basic $50 $70 $90 $110 Full Charge
Dental – Major $60* 45% of charges* 55% of charges* 65% of charges* Full Charge
*Plus 100% of supply/lab cost (if any)

2023 Federal Poverty Guidelines

Annual Income Limits (Effective 1/19/2023)
Discount Level A B C D E
FPG At or Below 100% 101-150% 151-175% 176-200% Above 200%
Household Size If income is ≤ If income is ≤ If income is ≤ If income is ≤ If income is ≤
1 $14,580 $21,870 $25,515 $29,160 $32,805
2 $19,720 $29,580 $34,510 $39,440 $44,370
3 $24,860 $37,290 $43,505 $49,720 $55,935
4 $30,000 $45,000 $52,500 $60,000 $67,500
5 $35,140 $52,710 $61,495 $70,280 $79,065
6 $40,280 $60,420 $70,490 $80,560 $90,630
7 $45,420 $68,130 $79,485 $90,840 $102,195
8 $50,560 $75,840 $88,480 $101,120 $113,760
9 $55,700 $83,550 $97,475 $111,400 $125,325
10 $60,840 $91,260 $106,470 $121,680 $136,890
For each additional person, add: $5,140 $7,710 $8,995 $10,280 $11,565
*Issued annually by the Department of Health and Human Services (HHS).

To apply or for more information about our Sliding Fee Discount Program, please contact our Patient Financial Advocate at 651-758-9472. 


How do I Apply for Sliding Fee Eligibility?

When you meet our Patient Financial Advocate, please bring the following documents or email them to SF@unitedfamilymedicine.org. Ask us for help if needed, to supply the forms for income verification.

  • Income information for each member of your family/dependents:
    • Earnings/wages; self-employment income; commissions: tips
    • Social security; supplemental security income (SSI); minor child SSI, alimony; workers compensation; estate or trust income; unemployment
    • Rental income; VA benefit; interest/dividends; annuities; public assistance; child support
    • Retirement/pension, educational assistance; gambling winnings, other financial assistance, and other sources of income that would be deemed taxable on an IRS tax return.

Discount Programs for Prescription Drugs

Established patients have access to discount programs regardless of their insurance status. We participate in the federal 340B Drug Pricing Program allowing us to purchase medications at a discount that we pass along to patients to help make prescriptions more affordable. This is available to everyone except patients who have Medicaid because most of their medication co-pays are already lower than 340B prices.

Just like some of the larger pharmacies, we have a list of drugs that are available for $4 (for a 30-day supply) and $10 (for a 90-day supply).

We do not accept manufacturer coupons or GoodRx.

Please ask about help paying for prescription drugs when you meet with your healthcare team.


United Family Medicine

United Family Medicine