Excellent Health & PRP Service

4000-4002 W Belvedere Ave., Unit A, Baltimore, MD 21215
Email: Excellenthealthcareprp@gmail.com
Phone: 410-304-6544

Fax: 443-869-3015

Sliding Fee Discount Program Policy

Excellent Healthcare & PRP Services offers a Sliding Fee Discount Program to all who are unable to pay for their services. EHPS will base program eligibility on a person’s ability to pay and will not discriminate on the basis of an individual’s race, color, sex, national origin, disability, religion, age, sexual orientation, or gender identity. The Federal Poverty Guidelines are used in creating and annually updating the sliding fee schedule (SFS) to determine eligibility.

The following guidelines are to be followed in providing the Sliding Fee Discount Program.

    1. Notification: EHPS will notify individuals of the Sliding Fee Discount Program by:
      • Payment Policy will be available to all uninsured individuals at the time of
      • Notification of the Sliding Fee Discount Program will be offered to each individual upon
      • EHPS places notification of Sliding Fee Discount Program in the clinic waiting
    2. All individuals seeking healthcare services at EHPS are assured that they will be served regardless of ability to pay. No one is refused service because of lack of financial means to pay.
    3. Request for discount: Requests for discounted services may be made by individuals, family members, or others who are aware of existing financial hardship. The Sliding Fee Discount Program will only be made available for clinic visits. Information can be obtained from the Front Desk.
    4. Administration: The Sliding Fee Discount Program procedure will be administered through the Billing Manager or his/her Information about the Sliding Fee Discount Program policy and procedure will be provided and assistance offered as needed. Dignity and confidentiality will be respected for all who seek and/or are provided healthcare services.
    5. Alternative payment sources: All alternative payment resources must be exhausted, including all third-party payment from insurance(s), federal and state programs.
    6. Completion of Application: At intake and annually thereafter, the individual/responsible party provides information about income to the administrative staff at the This information is used to determine eligibility for the Sliding Fee Discount Program.
    7. Eligibility: Discounts will be based on income and family size only. EHPS uses the Census Bureau definitions of each. a. Family is defined as: a group of two people or more (one of whom is the householder) related by birth, marriage, or adoption and residing together; all such people (including related subfamily members) are considered as members of one family. b. 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 Noncash benefits (such as food stamps and housing subsidies) do not count.

    1. Income verification: Individuals are encouraged to provide one of the following: prior year W2, two most recent pay stubs, letter from employer, or Form 4506-T (if W-2 not filed). Self-employed individuals will be encouraged to submit detail of the most recent three months of income and expenses for the business. Adequate information assists us to determine eligibility for the program. Self- declaration of Income may be used if other documentation is not readily All individuals must provide a signed statement of income. This statement will be presented to EHPS Program Director or his/her designee for review and final determination as to the sliding fee percentage.
    2. Discounts: Those with incomes at or below 100% of poverty will receive a full 100% discount. Those with incomes above 100% of poverty, but at or below 200% of poverty, will be charged according to the attached sliding fee schedule. The sliding fee schedule will be updated during the first quarter of every calendar year with the latest Federal Poverty Guidelines.
    3. Waiving of Charges: In certain situations, individuals may not be able to pay the discounted fee. Waiving of charges may only be used in special circumstances and must be approved by EHPS Program Director or their designee. Any waiving of charges should be documented in the individual’s file along with an explanation.
    4. Notification: The Sliding Fee Discount Program determination will be provided to the individual(s) in writing, and will include the percentage of Sliding Fee Discount Program write off. If the individual is approved for less than a 100% discount or denied, the individual and/or responsible party must immediately establish payment arrangements with EHPS. The Sliding Fee Discount Program covers outstanding balances for six months prior to the date of the financial information update and any balances incurred within 12 months after this date, unless their financial situation changes The individual has the option to provide additional information anytime there has been a significant change in family income in order for a review of his/her discount to occur.
    5. Refusal to Pay: If an individual verbally expresses an unwillingness to pay or vacates the premises without paying for services, he/she will be contacted in writing regarding their payment obligations. If the individual is not on the sliding fee schedule, a copy of the sliding fee discount program information will be sent with the notice. If the individual does not make effort to pay or fails to respond within 60 days, this constitutes refusal to At this point in time, EHPS can explore options not limited, but including offering a payment plan or waiving of charges.
    6. Record keeping: Information related to Sliding Fee Discount Program decisions will be maintained and preserved in each individual’s clinical record.
    7. Policy and procedure review: Annually, the amount of Sliding Fee Discount Program provided will be reviewed by the Program Director. The SFS will be updated based on the current Federal Poverty Guidelines. Pertinent information comparing amount budgeted and actual community care provided shall serve as a guideline for future planning. This will also serve as a discussion base for reviewing possible changes in our policy and procedures and for examining institutional practices which may serve as barriers preventing eligible individuals from having access to our community care provisions.