Financial Assistance Programs

Providing health care that is accessible to everyone is part of Sawtooth Mountain Clinic’s mission. If you are uninsured, underinsured, are on Medicare or Medicaid, or have questions about the cost of care, we are here to help. SMC offers financial assistance for patients through payment plans and a Sliding Fee Scale Program. We also have a MNsure Navigator on staff who can answer questions about insurance programs and assist in the application and enrollment process.

Payment Plans

Do you have questions or concerns about paying a bill or paying on time? A patient payment plan may be a good option for you. Call us to learn more.

Insurance Assistance

If you are uninsured or have questions about your insurance coverage, we can help. Call and ask to speak to our MNsure Navigator who is available to meet one-on-one with individuals and families.

MNSure.org

Sliding Fee Scale Program

2019-2020 Application

Info Sheet

What is Sawtooth Mountain Clinic’s Sliding Fee Scale Program?

The Sliding Fee Scale Program is a federal program that permits SMC to reduce the normal costs of medical, dental, behavioral health, pharmacy, and other services for patients who qualify. All patients are encouraged to apply for the Sliding Fee Scale Program, whether or not they have insurance and regardless of immigration status. Eligibility for the Sliding Fee Scale Program is based on:

  • The number of people who live in your home (spouse, children, dependents)
  • The amount of money earned by the people in the home

How can the Sliding Fee Scale Program help you?

The program reduces your cost for visits to SMC, as well as for the following services:

  • Pharmacy
  • Lab & X-ray
  • Dental
  • Vision

The Sliding Fee Scale Program also reduces costs for the following with a referral from an SMC Provider:

  • Physical Therapy
  • Occupational Therapy
  • Mental/Behavioral Health
  • Hearing Aids
  • Initial Consultation Visit with a Specialist

How much will I pay for services if I am on the Sliding Fee Scale Program?

How much you pay for services depends on your Sliding Fee Scale patient pay level. Sawtooth Mountain Clinic staff make the final determination on your level using the information you provide in your application. The following chart is an example and may help you estimate how the program might help reduce the cost of services:

 

Family size

Level A-Patient pays 0% of charge* Level B-Patient pays 10% of charge*    Level C-Patient pays 15% of charge* Level D-Patient pays 20% of charge* Patient pays 100% of charge
1 0-12,490 12,491-16,653 16,654-20,817 20,818-24,980 24,981+
2 0-16,910 16,911-22,547 22,548-28,183 28,184-33,820 33,821+
3 0-21,330 21,331-28-440 28,441-35,550 35,551-42,660 42,661+
4 0-25,750 25,751-34,333 34,334-42,917 42,918-51,500 51,501+
5 0-30,170 30,171-40,227 40,228-50,283 50,284-60,340 60,341+
6 0-34,590 34,591-46,120 46,121-57,650 57,651-69,180 69,181+
7 0-39,010 39,011-52,013 52,014-65,017 65,018-78,020 78,020+
8 0-43,430 43,431-57,907 57,908-72,383 72,384-86,860 86,861+

*Please note that for each level there is a nominal fee charged per appointment: $5 for Level A and no less than $5 for B, C, and D

How do I apply for the program?

Applying for the Sliding Fee Scale Program is easy! Just pick up an application, fill it out, and return it to the clinic with proof of your income. Staff will review your application and determine if you qualify for the program and at what level.

Proof of income

In order to qualify for the Sliding Fee Scale Program, you will need to provide information about your family and your income. The proof of income must be returned to SMC within 30 days of submitting the completed application. If you do not provide proof of income, your Sliding Fee Scale eligibility will end. If you file taxes, we will need a copy of your 1040. If you do not file taxes, contact the Sliding Fee Scale Program coordinator for assistance.

How long do I stay on the Sliding Fee Scale Program once I am approved?

Enrollment in the Sliding Fee Scale Program is good from June 1st of a given year to the next June 1st. All participants need to reapply and update their income each spring in order to remain on the program. If you have changes during the year with your household size and/or insurance coverage, please contact Sawtooth Mountain Clinic and ask to speak to with the Sliding Fee Scale Program coordinator.

Once my application is approved, what exactly will the Sliding Fee Scale Program cover?

CT Scan: When done at North Shore Health Hospital and ordered by a SMC provider

Consultation (Initial outpatient): When a referral is made by a Sawtooth Mountain Clinic Provider

Dental: For medically necessary services provided by Grand Marais Family Dentistry

Laboratory tests: At North Shore Health Hospital, must be ordered by a SMC Provider

Mental health/Behavioral Health Services: With a referral from a Sawtooth Mountain Clinic Provider, visits may be scheduled with Kelly Senty, MS at Steps of Change or Sherri Moe, MS MFT PC

MRI: with Mobile Unit available at North Shore Health Hospital, when ordered by an SMC Provider

Physical and Occupational Therapy: At North Shore Health Hospital or with Becky Stoner, PT at the Grand Marais Wellness Center; PT and OT must be ordered by a SMC Provider.

Prescription drugs: Prescriptions obtained at the Grand Marais Pharmacy in Grand Marais are covered when a Sawtooth Mountain Clinic Provider writes the prescription. Prescriptions are not covered if they are written for items available over-the-counter, except for diabetic supplies – these are covered with a written prescription (yearly) from one of Sawtooth Mountain Clinic’s providers.

Primary health care services: Must see a provider or nurse at SMC

X-ray and diagnostic tests: At North Shore Health Hospital, must be ordered by a SMC Provider

Vision Care: Basic vision exams up to twice per year as necessary when performed by St. Luke’s Ophthalmology Associates located at North Shore Health Hospital.  Sliding Fee Scale will NOT cover eyeglasses or contact lenses

Hearing Aid Assistance: For the purchase of hearing aids when arranged through hearing providers visiting SMC; assistance will be reviewed on a case by case basis and must be pre-approved

THE SLIDING FEE SCALE PROGRAM DOES NOT COVER emergency room, cardiac rehab, supplies, IV therapy, inpatient or observation at the hospital, nursing home charges, or prescriptions while in the Care Center, or as an inpatient. North Shore Health Hospital does have a Community Care program available for patients who qualify.

How does billing work?

Sawtooth Mountain Clinic will bill your insurance (if any). After insurance has been processed, you will be responsible for the amount after the Sliding Fee Scale is applied to the total charge. You will then be billed by Sawtooth Mountain Clinic for what you owe.

The terms and limitations of the Sliding Fee Scale Program are subject to change at any time.

If you need translation assistance, interpretive services are available in any language.

For more information about the Sliding Fee Scale Program, please contact Sawtooth Mountain Clinic at 218-387-2330 and ask for Karen at ext. 113.