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Financial Support Application

A&E Healthcare Services is committed to providing accessible healthcare services to all patients, regardless of financial circumstances. Patients who may qualify for discounted services based on household size and annual income may apply through our Sliding Fee Discount Program.

To apply, please download and complete the Financial Support Application below:

Financial Support Application Sliding Fee Schedule

A&E Healthcare Services offers a Sliding Fee Discount Program to help eligible patients access healthcare services regardless of financial circumstances. Discounts are based on household size and annual income in accordance with current Federal Poverty Guidelines.

Please review the Sliding Fee Schedule below for general eligibility guidance.

Please request an application to apply for a discount.

Why Do We Offer a Sliding Fee Discount?

A&E Healthcare Services Inc. is an approved National Health Service Corps (NHSC) facility committed to providing healthcare services regardless of a patient’s insurance status or ability to pay. Through our income-based Sliding Fee Discount Program, eligible patients may receive discounted services at all A&E Healthcare Services locations, including our mobile health unit.

Patients without insurance or who may be underinsured are encouraged to apply if they believe they meet the income eligibility guidelines. A patient may be considered underinsured if copays, deductibles, or other out-of-pocket medical expenses create a financial hardship.

Federal Poverty Level (FPL) percentages are based on the current U.S. Department of Health and Human Services (HHS) Federal Poverty Guidelines: https://aspe.hhs.gov/topics/poverty-economic-mobility/povertyguidelines

For questions about eligibility or assistance with the application process, please contact our office staff.

NOTICE TO PATIENTS:

No one will be denied access to services due to an inability to pay.

There is a discounted/sliding fee schedule available based on family size and income.

For more information, ask at the front desk or visit our website.

Thank you.

AVISO PARA PACIENTES:

Este establecimiento de salud atiende a todos los pacientes independientemente de su capacidad de pago.

Se ofrecen descuentos según el tamaño de la familia y los ingresos.

Para obtener más información, pregunte en la recepción o visite nuestro sitio web.