Patient Financial Assistance
Rockbridge Area Health Center offers a Sliding Fee Discount Program that may significantly reduce your healthcare costs at RAHC. This program is available to all of our patients — insured or uninsured.
How to Apply
- List all members of your household and sign the application. Please see the instructions on the application for more information on who to include in your household.
- Gather required proof of income. Please see the instructions on the application for more information.
- Submit the completed application and proof of income by mail, in person, or by fax to the contact info listed on the form.
- You will be contacted in 7-10 business days with a status. Applications submitted without proof of income will not be processed.
Forms
- Application and Instructions for Sliding Fee Discount Program
- Statement of Support (for patients with no source of income)
- Income Verification Form (for patients that do not receive pay stubs)
- Self Employment Verification Form
Formas en Español
- Solicitud para asistencia financiera – Programa de Escala Móvil
- Declaración De Apoyo (para pacientes sin fuente de ingresos)
- Vericación de Ingresos
- Autodeclaración para una visita
- Formulario de Verification de Autoempleo
| Household Size | Annual Income (200% FPL) |
|---|---|
| 1 | $30,120 |
| 2 | $40,880 |
| 3 | $51,640 |
| 4 | $62,400 |
| 5 | $73,160 |
| 6 | $83,920 |
| 7 | $94,680 |
| 8 | $105,440 |
| Each add'l | $10,760 |
Updated January 2024
Frequently Asked Questions
How do I apply?
Mail, fax, or deliver in-person the Application for the Sliding Fee Discount and proof of household income.
I work, so what should I submit?
Submit one month’s worth of pay stubs that show the gross amount, before taxes are taken out, for all adults on your tax return. RAHC looks at income before taxes are taken out.
What proof do you need for social security?
Please submit the current year’s Social Security Benefit letter.
How do I prove I don’t have income?
Submit the Statement of Support form signed by the patient and the person assisting with payment for services.
How long is the discount valid?
Patients with income must reapply each year. Patients with no income must reapply every six months.
I have insurance. Can I apply?
Yes! The requirements are based on household size and income.
Is this insurance?
No, this is not insurance.
How will I know if I am approved?
The patient will receive a phone call within 1-3 business days. RAHC will mail a letter with the discount card.
What do you count as income?
Wages, self-employment (profit), Social Security, alimony, retirement, investments, rental income, workers’ compensation, and unemployment.
What doesn’t get counted as income?
Minor income, child support, TANF or SNAP from Social Services, Supplemental Security Income, Veteran’s Disability, and veterans survivor benefits.
Will my discount help me outside of RAHC?
Yes, but only with organizations having an agreement with RAHC.
I have questions. Who should I call?
RAHC is available to answer any questions in person or by calling (540) 464-8700, and select option 3.