Monarch Therapeutic Services, LLC
SLIDING FEE PROGRAM
|
REQUESTS FOR DISCOUNTED PSYCHOTHERAPY SERVICES
Requests for discounted services may be made by patients, family members, social services staff or others who are aware of existing financial hardship. Discounted services would apply effective the date of application approval. Discounted rates start at $65/therapeutic hour. QUALIFYING FOR DISCOUNT Discounts will be based on income and family size only. Monarch Therapeutic Services, LLC defines a family as head of household, spouse and dependent children. Income includes: earnings, unemployment compensation, workers' compensation, Social Security, Supplemental Security Income, public assistance, veterans' payments, survivor benefits, pension or retirement income, interest, dividends, rents, royalties, income from estates, trusts, educational assistance, alimony, child support, assistance from outside the household, and other miscellaneous sources. Noncash benefits (such as food stamps and housing subsidies) do not count. Proof of Income must be provided: proof of income may include prior year W-2, two most recent bank statements and two most recent pay stubs. Self-employed individuals are required to submit detail of the most recent three months of income. Adequate information must be made available to determine eligibility for the program. Patients who are unable to provide written verification must provide a signed statement of income, and why he/she is unable to provide independent verification. This statement will be reviewed and final determination as to the sliding fee percentage will be made. Self-declared patients will be responsible for 100% of their charges until management determines the appropriate category. All alternative payment resources must be exhausted, including all third-party payment from insurance(s), Federal, and State programs. Notice: The Sliding Fee Discount Program determination will be provided to the applicant(s) in writing, and will include the percentage of Sliding Fee Discount Program write off, or, if applicable, the reason for denial. 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 six months or the expiration of their last Sliding Fee Discount Program application. |
APPLYING
The client/responsible party must complete the Sliding Fee Discount Program application in its entirety. Providing false information on a Sliding Fee Discount Program application will result in all Sliding Fee Discount Program discounts being revoked and the full balance of the account(s) restored and payable immediately. CLICK HERE TO APPLY Renewal Applications: A patient who receives discounted services under this policy is required to submit an updated application every 6 months and/or if their financial situation changes. Failure to meet the annual financial information requirement may result in the patient no longer being eligible for the Sliding Fee Discount Program. If a patient is delinquent in meeting the updated application requirement, Monarch Therapeutic Services, LLC will mail the patient a notice they are being terminated from the Sliding Fee Discount Program unless they submit the required financial information within the time frame (10 business days) noted in the letter. If a patient does not submit the renewal information, they are no longer eligible for the discounted services per the date in the notice letter. Refusal to Pay: If a patient verbally expresses an unwillingness to pay or vacates the session without paying for services, the patient will be contacted in writing regarding their payment obligations. If the patient is not on the sliding fee schedule, a copy of the sliding fee discount program application will be sent with the notice. If the patient does not make effort to pay or fails to respond within 60 days, this constitutes refusal to pay. At this point in time, Monarch Therapeutic Services, LLC can and will explore options not limited to, but including offering the patient a payment plan, waiving of charges, or referring for patient collections efforts. |