Sliding Fee Scale
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.)
Click here to see example of Sliding Fee Scale
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.
Sliding Fee Scale Covered Services
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.
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|
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|
information is provided for your reference only; it is not a guarantee
of coverage nor does it assure payment. This schedule may change
** We can and will assist you with your AHCCCS application.