Sliding Fee Scale

Chiricahua Community Health Centers, Inc. offers a sliding fee scale program for people who are uninsured or underinsured or AHCCCS ineligible. The sliding fee scale is based on your family size and income, (please note scale below). This fee scale allows you and your family to pay a reduced fee for covered medical services at Chiricahua Community Health Centers, Inc. In order to qualify for our sliding fee scale, you will need to complete a Patient Registration Form, as well as an Sliding Fee Program Application. All sliding fee scale patients are required to bring the following information with them to their eligibility appointment:

Address Verification (A utility bill, rent receipt, etc.)
Proof of Income (4 weeks of current pay stubs, Social Security statement, etc.)
Social Security Number*
A denial letter from AHCCCS**

Due to the amount of detail required, we encourage you to call one of your local clinic locations in order to make an appointment with one of our Eligibility personnel who will assist you through this process.

Click here to see example of Sliding Fee Scale

Sliding Fee Scale Covered Services

If you have been approved for the Sliding Fee Scale at Chiricahua Community Health Centers, Inc., this list is provided to give you a sample of what Medical tests and services are covered (and not covered) under the sliding fee scale.

The sliding fee scale program at Chiricahua Community Health Centers, Inc. applies to primary care services ONLY and ONLY when the services are ordered by Chiricahua Community Health Centers, Inc. provider. The following list is provided as a sample of covered services that are provided at Chiricahua Community Health Centers, Inc. facility.

Plain Film X-Rays	Spot Compressions	Upper & Lower GI
Mammograms	Bone Density/DEXA Scans	Barrium Enemas
IVP	Biophysical Profiles	Pulmonary Function Tests
Doppler Studies (Venous & Carotid)	OB Non-Stress Tests	Basic Laboratory Tests
Ultrasounds	Breast Untrasounds

If you have been referred for a test OR to a physician who is not at Chiricahua Community Health Centers, Inc. , please note that you will be responsible for the fees for that service.

Examples of services that are not covered include, but are not limited to, the following:

Speciality Consults	Specialty Care/Treatments	Major Surgical Procedures
Hospitalization	Emergency Room Services	OB Delivery
Newborn Care (in Hospital)	Cardiac Stress Tests	Echocardiograms
CT Scans	MRI

This information is provided for your reference only; it is not a guarantee of coverage nor does it assure payment. This schedule may change without notice.

** We can and will assist you with your AHCCCS application.