What to Bring for Financial Assistance

The People’s Community Clinic provides healthcare for the uninsured based on a sliding scale.

The sliding fee is determined based on your household income and the size of your household. During your financial screening you will also be screened for possible healthcare program eligibility. In order to provide this service to you we do require you to bring the items listed below.

In order to ensure proper placement on the sliding scale year-round, please provide us with information about changes to your household size and any income decreases or increases.

  1. Photo Identification.

    Any identification with your picture and name on it. Examples include:

    • Driver’s license
    • School ID
    • Work ID
  2. Medical Insurance Information, if applicable.

    • Medicaid/Amerigroup/Superior
    • Medicare
    • Children’s Health Insurance Plan (CHIP)
  3. Proof of Address/County.

    Examples include:

    • Utility bill
    • Cable bill
    • Cell phone bill
    • Bank statement
    • Voter registration card
  4. Recent proof of income for the last 30 days. Income from patient, spouse or live-in partner is required.

    Examples include:

    • Paycheck stub
    • Bank statement
    • Tax return
    • Social Security statement
    • Child support information
    • Workforce unemployment letters
  5. Proof of income if paid in cash.

    Bring a recent letter (within 30 days) from your employer that includes the following:

    • The amount and frequency of payment being received
    • Signature of employer
    • Telephone number of employer
    • Date the letter was written
  6. No Source of Income.

    If you are unemployed and do not have any other source of income (such as a spouse) and are being supported by a family member, friend or organization, they may supply a letter for you verifying this information. The letter should be recent (within 30 days) and include the following:

    • Name, address and phone number of the person providing you with assistance
    • Statement that the patient has no income or employment and is receiving financial assistance from the person writing the letter
    • Date the letter was written
    • If monetary value is given, it must be listed on the letter
    • If homeless, a letter from the agency or shelter helping you is accepted.
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