Bronson Sliding Fee Discount
Bronson Healthcare Rural Health Location
Download the Rural Healthcare Sliding Fee Discount Application (PDF)
Download the Rural Healthcare Sliding Fee Policy (PDF)
Purpose
All patients seeking primary care services at Bronson Healthcare are assured that they will be served regardless of their inability to pay. This program is designed to provide free or discounted care to those who have no means, or limited means, to pay for their medical services(uninsured or underinsured).
Bronson Healthcare will offer a Sliding Fee Discount to all who are unable to pay for their services. Bronson Healthcare will base eligibility on a person’s ability to pay and will not discriminate on the basis of an individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, gender identity, ability to pay, or whether payment for those services would be made under Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP). The Federal Poverty guidelines are used in creating and annually updating the sliding fee schedule to determine eligibility.
Policy
The Sliding Fee Discount will be available to all individuals and families with annual incomes at or below 350% of the most current Federal Poverty Guidelines. The discount will be based solely on family size and income. This is applicable to all eligible patients to promote access to healthcare services.
Requests for discounted services may be made by patients, family members, social services staff, or others who are aware of an existing financial hardship. The Sliding Fee Discount is available for clinic visits only. Information and forms are available at the front desk, business office, or on this webpage.
Sliding fee schedule applies to the designated Rural Healthcare Clinics below:
- Bronson LakeView Family Care, Suite A, Paw Paw
- Bronson LakeView Family Care, Suite B, Paw Paw
- Bronson LakeView Family Care, Suite G, Paw Paw
- Bronson LakeView Family Care Internal Med., Paw Paw
- Bronson LakeView Family Care Pediatrics, Paw Paw
- Bronson LakeView Family Care - Decatur
- Bronson LakeView Family Care - Bangor
- Bronson LakeView Family Care - Blue Star, South Haven
- Bronson South Haven Family Med.
- Bronson South Haven Internal Med.
- Bronson South Haven Pediatrics
- Bronson Obstetrics, Gynecology and Midwifery Specialists - South Haven
The Sliding Fee Discount procedure will be administered through the business off manager or his/her designee. Information about the Sliding Fee Discount will be provided to patients. Staff are to offer assistance for completion of the application. Dignity and confidentiality will be respected for all who seek and/or are provided health care services.
Information related to the Sliding Fee Discount decisions will be maintained and preserved in a centralized confidential file located in the office of the business manager, in an effort to preserve the dignity of those receiving free or discounted care. Applicants that have been approved for the Sliding Fee Discount will be logged in Bronson Healthcare’s practice management system, noting names of applicants, dates of coverage and percentage of coverage. The business office manager will maintain an additional monthly log identifying Sliding Fee Discount recipients and dollar amounts. Denials and applications not returned will also be logged.
Eligibility Criteria
- Income Verification:
- Patients must provide proof of income, which can include the prior year W-2, two most recent pay stubs, a letter from employer, or Form 4506-T (if W-2 not filed). Self-employed individuals will be required to submit prior year’s personal tax return and a tax return for the individual’s business including all schedules. Adequate information must be made available to determine eligibility. A self-declaration of income may be used. Patients who are unable to provide written verification may provide a signed statement of income.
- Bronson uses the Census Bureau definition of family income. It considers the following sources as income in relation to the federal poverty guidelines:
- Gross wages; salaries; tips; income from business and self-employment; unemployment compensation; workers’ compensation; Social Security; Supplemental Security Income; veterans’ payments; survivor benefits; pension or retirement income; interest; dividends; royalties; income from rental properties, estates, and trusts; alimony; child support; assistance from outside the household; and other miscellaneous sources.
- Family Size:
- Family is defined as: a group of two people or more (one of whom is the householder) related by birth, marriage, or adoptions and residing together; all such people (including related subfamily members) are considered as members of one family. Bronson Healthcare will also accept non-related household members when calculating family size.
- Annual Income Threshold:
- At a minimum, individuals and families with annual incomes at or below 350% of the Federal Poverty Guidelines will be eligible for the sliding fee discount.
Application Process
- Patient Application:
- Patients must complete a Sliding Fee Discount application, providing accurate information about their income and family size.
- Supporting Documentation:
- Patients must submit required supporting documentation to verify their income and family size.
- Review and Approval:
- Applications will be reviewed by the site’s designated staff to determine eligibility. The determination will be provided to the applicant(s) in writing and will include the percentage of the Sliding Fee Discount write off, or if applicable, the reason for denial.
- Sliding Fee Discount applications cover outstanding balances for 240 days prior to application date and any balances incurred within 12 months after the application date, unless their financial situation changes significantly.
- Renewal:
- Eligibility must be reassessed annually, requiring patients to submit updated documentation to continue receiving the discount.
- The applicant has the option to reapply after the 12 months have expired or anytime there has been a significant change in family income. When the applicant reapplies, the look back period will be the lesser of 240 days or the expiration of their last Sliding Fee Discount Program application.
Discount Schedule
Patients with incomes above 200% of poverty, but at or below 350% poverty will be charged a nominal fee according to the sliding fee schedule below. This is based on family size and income. However, patients will not be denied services due to inability to pay. The nominal fee is not a threshold for receiving care, and thus is not a minimum fee or co-payment.
2025 Federal Poverty Level (FPL) Guidelines Reference
| Family Size |
2025 FPG |
200% |
250% |
300% |
350% |
| 1 |
$15,650.00 |
$31,300.00 |
$39,125.00 |
$46,950.00 |
$54,775.00 |
| 2 |
$21,150.00 |
$42,300.00 |
$52,875.00 |
$63,450.00 |
$74,025.00 |
| 3 |
$26,650.00 |
$53,300.00 |
$66,625.00 |
$79,950.00 |
$93,275.00 |
| 4 |
$32,150.00 |
$64,300.00 |
$80,375.00 |
$96,450.00 |
$112,525.00 |
| 5 |
$37,650.00 |
$75,300.00 |
$94,125.00 |
$112,950.00 |
$131,775.00 |
| 6 |
$43,150.00 |
$96,300.00 |
$107,875.00 |
$129,450.00 |
$151,025.00 |
| 7 |
$48,650.00 |
$97,300.00 |
$121,625.00 |
$145,950.00 |
$170,275.00 |
| 8 |
$54,150.00 |
$108,300.00 |
$135,375.00 |
$162,450.00 |
$189,525.00 |
| For each additional person, add |
$5,500.00 |
$11,000.00 |
$13,750.00 |
$16,500.00 |
$19,250.00 |
Income Levels and Discount Rates for Sliding Fee Discount
Income Level (as % of FPL)
Family Income as a Percentage of FPL |
Discount on Charges
Family Income as a Percentage of FPL |
| Up to 200% |
100% |
| Up to 250% |
90% |
| Up to 300% |
80% |
| Up to 350% |
75% |
Billing and Collections
Patients will be contacted in writing regarding their payment obligations. If the patient does not make an effort to pay or fails to respond within 120 days, this constitutes refusal to pay. Please see Bronson's Billing and Collection Policy page for further information including extraordinary collection efforts.
Notification
Bronson Healthcare will notify patients of the Sliding Fee Discount by:
- Payment Policy Brochure will be available to all patients at the time of service.
- Notification of the Sliding Fee Discount will be offered to each patient upon admission.
- An explanation of our Sliding Fee Discount and our application form are available on Bronson Healthcare's website.
- Bronson Healthcare places notification of the Sliding Fee Discount in the clinic waiting area.
Review
The Sliding Fee Schedule will be updated annually to reflect the current Federal Poverty Guidelines. Bronson Healthcare will also review possible changes in our policy and procedures and for examining institutional practices which may serve as barriers preventing eligible patients from having access to our community care provisions.
Contact Information
For more information or assistance with the Sliding Fee Discount, please contact:
Bronson Billing Department
(800) 699-6117 or (269) 341-6117
Email: PatientBilling@bronsonhg.org
Definitions
- Uninsured: Individuals with no private health insurance, Medicare, Medicaid, State Children's Health Insurance Program, state-sponsored, over government, or military health coverage.
- Underinsured: Individuals with public or private insurance policies that do not cover all necessary medical services, resulting in out-of-pocket expenses that exceed their ability to pay.
References
This policy ensures compliance with the requirements outlined in the image and promotes access to healthcare services for all patients based on their financial situation.
VDownload the Rural Healthcare Sliding Fee Discount Application (PDF)
Download the Rural Healthcare Sliding Fee Policy (PDF)
