Effective Date: February 9, 2026
Review Cycle: Annual
Applies To: All self-pay and non-covered services
1. Purpose
The purpose of this policy is to ensure equitable access to medically necessary eye care services for patients with financial need, while maintaining financial sustainability and compliance with applicable federal and state regulations. The Sliding Fee Scale (SFS) establishes a standardized method for adjusting patient charges based on household income and family size.
2. Policy Statement
Eye Health Clinic, PA (doing business as Bright Futures Vision Clinic) provides a Sliding Fee Scale for eligible patients whose household income is at or below 200% of the Federal Poverty Guidelines (FPG). Discounts are applied uniformly and without regard to race, color, religion, sex, sexual orientation, gender identity, age, disability, national origin, or payer status.
The Sliding Fee Scale applies only to eligible services and does not replace or override contractual obligations with insurance carriers or government payers.
3. Scope of Services
The Sliding Fee Scale applies to:
- Self-pay comprehensive eye examinations
- Non-covered medical eye services
- Preventive and medically necessary services not reimbursed by a third-party payer
The Sliding Fee Scale does not apply to:
- Services covered and billed to insurance, Medicare, or Medicaid
- Retail optical products (frames, lenses, contact lenses)
- Elective or cosmetic services
- Services subject to separate written pricing policies
4. Eligibility Criteria
Eligibility is determined based on:
- Household income
- Household (family) size
- Comparison to the current year Federal Poverty Guidelines (FPG)
Patients with household income greater than 200% of FPG are not eligible for Sliding Fee Scale discounts and are responsible for the full fee.
5. Sliding Fee Scale Structure (2026)
Usual & Customary Full Fee Clinic Dependent
| Income Level (% of 2025 FPG) | Patient Responsibility |
|---|---|
| ≤ 100% | 50% off |
| 101% – 130% | 40% off |
| 131% – 150% | 30% off |
| 151% – 175% | 20% off |
| 176% – 200% | 10% off |
| > 200% | Full Fee |
Nominal fees are intended to offset administrative costs and encourage shared responsibility; free care is not routinely provided. https://www.needymeds.org/federal-poverty-level-calculator
6. Required Documentation
Patients requesting Sliding Fee Scale consideration must submit current proof of income, which may include:
- 2025 federal tax return
- SSA benefit verification letter /award letter
- Foster Placement Letter/Placement Authorization (dated within 6 months)
- Written verification of unemployment with date and wet signature
Documentation must be reviewed, approved, and uploaded before discounted services are rendered. No exceptions. Must have
7. Determination & Duration of Eligibility
- Eligibility determinations are made by designated clinic staff using standardized criteria
- Approved Sliding Fee Scale status is valid for 12 months, unless a significant change in income or household size occurs and documentation is provided.
- Patients are responsible for notifying the clinic of changes that may affect eligibility.
8. Consistency & Non-Discrimination
The Sliding Fee Scale is applied consistently to all eligible patients. Staff may not waive fees, apply discounts, or alter eligibility criteria outside of this policy.
Failure to apply the policy uniformly may result in disciplinary action and compliance risk.
9. Capacity Limits
To ensure financial sustainability, the clinic may limit Sliding Fee Scale appointments to a defined portion of total patient volume, generally no more than 10% of active visits. Availability is not guaranteed and may vary by location or provider.
10. Annual Review & Updates
This policy and fee schedule shall be reviewed annually and updated to reflect:
- Changes in Federal Poverty Guidelines
- Changes in clinic operating costs
- Regulatory or payer compliance requirements
Updates will be effective January 1 of each calendar year unless otherwise stated.
11. Recordkeeping & Audit Readiness
All Sliding Fee Scale applications, income documentation, and determinations shall be retained in the patient record in accordance with record retention policies and applicable law.
12. Questions & Appeals
Patients may request clarification regarding the Sliding Fee Scale process. Appeals of eligibility determinations must be submitted in writing and will be reviewed by clinic management. Appeals may take up to 4 weeks; determinations are final.