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

2018-2019 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 0-12,060 12,061-16,080 16,081-20,100 20,101-24,120 24,121+
2 0-16,240 16,241-21,653 21,654-27,067 27,068-32,480 32,481+
3 0-20,420 20,421-27,227 27,228-34,033 34,034-40,840 40,841+
4 0-24,600 24,601-32,800 32,801-41,000 41,001-49,200 49,201+
5 0-28,780 28,781-38,373 38,374-47,967 47,968-57,560 57,561+
6 0-32,960 32,961-43,947 43,948-54,933 54,934-65,920 65,921+
7 0-37,140 37,141-49,520 49,521-61,900 61,901-74,280 74,281+
8 0-41,320 41,321-55,093 55,094-68,867 68,868-82,640 82,641+

*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, 1040A, or 1040EZ. 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 1 of a given year to the next June 1. 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 SMC and ask to speak to Erin Watson.

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

CT Scan: When done at North Shore Health and ordered by an SMC Provider.

Consultation (initial outpatient): When a referral is made by an SMC Provider.

Dental: For medically necessary services provided by Dr. Hedstrom’s office, Grand Marais Family Dentistry.

Lab and x-ray charges from Duluth: Medtox will be covered for pathology. X-ray charges from Consulting Radiologists of Minneapolis will be covered for x-ray interpretations when services are ordered through a clinic visit and performed at the North Shore Health Hospital.

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

Mental health/behavioral health services: With a referral from an SMC Provider, visits may be scheduled with Wayne Arnzen, MA LP; Kelly Senty, MS at Steps of Change; Sherri Moe, MS MFT PC; the Human Development Center.

MRI: One time per calendar year 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 an SMC Provider.

Prescription drugs: Obtained at the Grand Marais Pharmacy or the Arrowhead Pharmacy in Grand Marais are covered when an SMC 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 SMC’s Providers. Also, prescriptions will not be covered when patients have Medicare Part D coverage.

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 an 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, the remainder will be adjusted according to your Sliding Fee Scale patient pay level. You will then be billed by SMC 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 SMC at 218-387-2330 and ask for Erin Watson at ext. 153qa.