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.

Family Size0%
20%40%
60%
80%
100%
1
Annual/
Monthly
$0 to $12,060/
$1,005
$12,061 to $15,075/
$1,256.25
$15,076 to $18,090/
$1,507.50
$18,091 to $21,105/
$1,758.75
$21,106 to $24,120/
$2,010
$24,121 and over/
$2,010
2
Annual/
Monthly
$0 to $16,240/
$1,353.33
$16,241 to $20,300/
$1,691.67
$20,301 to $24,360/
$2,030
$24,361 to $28,420/
$2,368.33
$28,421 to $32,480/
$2,706.67
$32,481 and over/
$2,707
3
Annual/
Monthly
$0 to $20,420/
$1,701.67
$20,421 to $25,525/
$2,127.08
$25,526 to $30,630/
$2,552.50
$36,631 to $35,735/
$2,977.92
$35,736 to $40,840/
$3,403.33
$40,841 and over/
$4,100
4
Annual/
Monthly
$0 to $24,600/
$2,050
$24,601 to $30,750/
$2,562.50
$30,751 to $36,900/
$3,075
$36,901 to $43,050/
$3,587.50
$43,051 to $49,200/
$4,100
$49,201 and over/
$4,100
5
Annual/
Monthly
$0 to $28,780/
$2,398.33
$28,781 to $35,975/
$2,997.92
$35,976 to $43,170/
$3,597.50
$43,171 to $50,365/
$4,197.08
$50,366 to $57,560/
$4,796.67
$57,561 and over/
$4,797
6
Annual/
Monthly
$0 to $32,960/
$2,746.67
$32,961 to $41,200/
$3,433.33
$41,201 to $49,440/
$4,120
$49,441 to $57,680/
$4,806.67
$57,681 to 65,920/
$5,493.33
$65,921 and over/
$5,493
7
Annual/
Monthly
$0 to $37,140/
$3,095
$37,141 to $46,425/
$3,868.75
$46,426 to $55,710/
$4,642.50
$55,711 to $64,995/
$5,416.25
$64,996 to $74,280/
$6,190
$74,281 and over/
$6,191
8
Annual/
Monthly
$0 to $41,320/
$3,791.67
$41,321 to $51,650/
$4,304.17
$51,651 to $61,980/
$5,165
$61,981 to $72,310/
$6,025
$72,311 to $82,640/
$6,886.67
$82,641 and over/
$6,887
9
Annual/
Monthly
$0 to $45,500/
$3,791.67
$45,501 to $56,875/
$4,739.58
$56,876 to $68,250/
$5,687.50
$68,251 to $79,625/
$6,635.42
$79,626 to $91,000/
$7,583.33
$91,001 and over/
$7,583
10
Annual/
Monthly
$0 to $49,680/
$4,140
$49,681 to $62,100/
$5,175
$62,101 to $74,520/
$6,210
$74,521 to $86,940/
$7,245
$86,941 to $99,360/
$8,280
$99,361 and over/
$8,280

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.

* 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.