Download Your Benefits - ValleyHealth.org

Sliding Fee Scale Program
Welcome to Your Benefits
The benefits you receive under Valley Health’s
Sliding Fee Program can be used for medical
and dentistry services provided at any of our
convenient neighborhood locations.
A Woman’s Place
Carl Johnson
Children’s Clinic, Point Pleasant
Fort Gay
Gallipolis Ferry
Grant
Harts
Highlawn
Huntington
Hurricane
Ironton
Pharmacy
Southside
Stepptown
Upper Kanawha
Wayne
Westmoreland
Women’s Health, Point Pleasant
304.697.2014
304.529.4734
304.675.4107
304.648.5544
304.675.5725
304.743.4444
304.855.4595
304.781.5138
304.525.0572
304.760.6040
740.532.1188
304.525.4112
304.529.0645
304.393.4090
304.595.1770
304.272.5136
304.781.5800
304.675.3405
Children’s Clinic
Women’s Health
Gallipolis
Ferry
Mason County
Ironton
Ohio
Milton
Guyandotte
Westmoreland
Huntington
Putnam
County
CHARLESTON, WV
Cabell
County
Cedar
Grove
Wayne
Fort Gay
Hurricane
Wayne
County
Lincoln
County
Kanawha
County
www. valleyhealth .org
Harts
Stepptown
304.525.3334
Information for Approved Applicants
Sliding Fee Scale Program
YOUR BENEFITS
Welcome. You have been approved, based on annual
household income, to participate in Valley Health’s Sliding
Fee Scale Program. Please review this brochure to
understand the service discounts you can receive as a
patient. The letter included with this brochure identifies
the scale for which you have qualified.
MEDICAL SLIDING FEE SCALE
SCALE A: The patient is responsible for
20% of usual charges, with payment of
$25 due at time of visit.
SCALE B: Patient is responsible for
30% of usual charges, with a minimum
payment of $30 due at time of visit.
SCALE C: Patient is responsible for
40% of usual charges, with a minimum
payment of $50 due at time of visit.
NONCOVERED MEDICAL SERVICES
There are select medical services provided by Valley
Health that the Sliding Fee Scale Program does not
cover. Patients will be responsible for 100% of usual
charges for services including, but not limited to:
· Injections
· Medications
· Medical Devices (IUDs, etc.)
Also not included under our Sliding Fee Scale
Program are services provided by any medical
facility or provider outside the Valley Health
network. Examples include, but are not limited
to, hospital fees for surgeries performed in the
hospital, fees for radiology services and fees for
lab work processed by an outside lab. Patients
can expect to be billed directly by the outside
medical entity and will be responsible for paying in full.
BEHAVIORAL HEALTH AND
DENTAL SLIDING FEE SCALE
• There are only two sliding fee scale categories for
behavioral health and dentistry services: 50% and 75%.
• The minimum charge for behavioral health and dentistry
services is $50. Charges will not be discounted below this level.
SCALE A, SCALE B, SCALE C: Patient is responsible for
50% of usual charges, with full payment due at time of visit.
SCALE D: Patient is responsible for 75% of usual
charges, with full payment due at time of visit.
For dentistry services, all patients, regardless of type of
slide, will be required to pre-pay the entire amount for
which they are responsible before the dental procedure
begins. If a patient carries dental insurance, Valley Health
will reimburse the patient when payment is received
from the insurance carrier.
SCALE D: Patient is responsible for
50% of usual charges, with a minimum
payment of $70 due at time of visit.
MAINTAINING YOUR BENEFITS
To keep your sliding fee scale
benefits active, you will need
to submit a renewal application
each year. We will send you a
letter one month before your
current benefits are scheduled
to expire as a reminder to
submit a new application.
For more information about Valley
Health, please call: 304-525-3334
www. valleyhealth .org
MAJOR RESTORATIVE WORK IS NOT COVERED
under Valley Health’s Sliding Fee Scale Program.
Patients will be responsible for 100% of usual
charges for services including, but not limited to:
• Outside Lab Work
• All Orthodontic Appliances
• Dentures
• Bleaching Trays
• Mouth Guards
• Denture/Partial/Flipper:
Repairs Sent Outside Lab
• Night Guards
• Crowns
• Splints
• Partials
• Mouth Guards
• Flippers
• Bridges