Payment Options & Information

Sliding Fee Discount Program

Eligibility for the sliding fee discount program is based on income and family size — no other factors. Riverland Community Health will not turn any patient away for failure to pay outstanding bills or inability to pay the nominal fee for any service.

To apply for sliding fee please submit your proof of income within 90 days of your visit.  A Patient advocate will process your application  and let you know if you qualify for the discount.

Proof of family income consists of at least one of the following:

• Two paystubs received within recent 30-day timeframe – if cumulative annual salary or gross wage is noted.
• Letter from employer if paid in cash – must be on company letterhead or notarized.
• Unemployment compensation statements
• SSI/Disability check (photocopy) or current award letter
• Pending Public Assistance Application with notation of determined income/family wage level
• Notarized letter of support from family members/friends/other agency
• Most current tax returns (W-2 not accepted) showing annual gross income of family must include signature page.
• Any/all additional forms of income, including alimony.
• Self-disclosure (All other forms of family income must first be considered, and the patient financial advocate will provide a checklist to document this attestation. Only the patient financial advocate and billing staff may determine the use of self-disclosure as a form of family income.)