Payment

Fairfax Medical Facilities accepts Medicare, Medicaid, SoonerCare, and most types of health insurance. If you do not have health insurance, your fees for services are based on a sliding fee scale. We want everyone that needs services to be able to receive them.

The sliding fee scale is a discount of charges for those who either have no insurance, or who have insurance but have a high deductible. Also, it is for those whose insurance does not cover provided services. Regardless of whether you have insurance or not, you must still meet the income guidelines. The sliding fee scale is a formula used to determine the availability of reduced charges to patients who qualify according to the number in the family and the average yearly income of the family.

# In Family0%
(100%)
20%
(125%)
40%
(150%)
60%
(175%)
80%
(200%)
100%
(>201%)
1$0
$11,490
$11,491
$14,362
$14,363
$17,234
$17,235
$20,107
$20,108
$22,980
more than
$22,981
2$0
$15,610
$15,511
$19,388
$19,389 $22,265$22,266 $27,143$27,144 $31,020 more than $30,021
3$0
$19,530
$19,531
$24,413
$24,414
$29,295
$29,296
$34,178
$34,179
$39,060
more than
$39,061
4$0
$23,550
$23,551
$29,438
$29,439
$35,325
$35,326
$42,213
$42,214
$47,100
more than
$47,101
5$0
$27,570
$27,571
$34,463
$34,464
$41,355
$41,356
$48,248
$48,249
$55,140
more than
$55,141
6$0
$31,590
$31,591
$39,488
$39,489
$47,385
$47,386
$55,283
$55,284
$63,180
more than
$63,181
7$0
$35,610
$35,611
$44,513
$44,514
$53,415
$53,416
$62,318
$62,319
$71,220
more than
$71,221
8$0
$39,630
$39,631
$49,538
$49,539
$59,445
$59,446
$69,353
$69,354
$79,260
more than
$79,261

HOW TO READ THE SCALE

Step 1: Locate the row corresponding to the number of individuals in your family.
Step 2: Move to the right until you find the range containing your average annual income.
Step 3: Go to the top of that column. The percentage shown is the portion of the bill you will pay.

For each additional family member over 8 add $3,820. For the 20% category, the patient will be responsible for 20% of the bill or $20, whichever is higher.In the 0% category, the patient is asked to pay $20 for office visit, $20 for routine lab work, $20 for x-ray, and $20 for injections.

* You Must Provide Proof of Income by presenting at least one of the items listed below

  • Tax Forms from the most recent year
  • Paycheck stubs for three months with year to date income provided
  • Fixed income statement (example: pension, social security or all eligible on all eligible bank statements showing deposits)
  • Signed notarized letter from, example: Minister, Law enforcement, City hall or Lawyer verifying financial status, housing situation, and how you cover expenses.
  • Student grant information
  • If you are self-employed, tax forms from current year and a profit/loss statement.

* You must provide proof of address by presenting at least one of the items listed below

  • Required-Drivers license or state issued ID card
  • Utility bill

REMEMBER All family income is to be included. Income is the AMOUNT EARNED BEFORE TAXES ARE DEDUCTED.