Sliding Fee
Information for Patients – Required Documentation
Please call (973)789-8111 to find out more on our sliding fee discounts available to all patients. Discounts are based on income and family size which are verified by the following documents.
Proof of Income
- W-2 Income Tax Withholding Form
- Unemployment Insurance
- Letter from employer on their letterhead stating annual income (employer’s telephone should be available for confirmation of information) or Notarized letter indicating source of income
Proof of Age and Family Size
- Birth Certificate
- Driver’s License
- Marriage License
- Baptismal Certificate
- W-2 Income Tax Withholding Form
***If the patient fails to produce the appropriate documentation which satisfies the above-mentioned criteria after the second visit, that patient may billed at the full rate.***
SLIDING FEE BREAKDOWN
SERVICE FEES
Saint James Health has a sliding fee discount program to ensure affordable access to all services. Fees are based on services received and can be adjusted based on your income and family size. Fees for medical services typically range from $30 to $120
