Sliding Fee Scale

Affordable Care Costs Tailored to You

Prism Health North Texas offers an affordable option for your care by having a Sliding Fee Scale. Rates are discounted based on household income and household size.

To qualify for the sliding fee scale, complete an application and submit supporting income documents. Upon submission, a Financial Navigator will review your application and documents to determine your eligibility.

Sliding Fee Scale Application Instructions

1. Complete the application (in English / en Español).

2. To determine the appropriate fees for services, please have the below documents handy. Fees will vary based on your eligibility, family size, and gross monthly income. Acceptable forms of documentation include:

• • Last year’s income tax return or W-2
  • Pay stubs from the 4 most recent weekly or 2 biweekly pay periods
  • Unemployment check(s)
  • Social Security (SSI) checks or statements
  • Pension checks
  • Proof of alimony, child support, etc.
  • Verification of income by employer
  • Bank statements showing direct deposits

3. Submit the application online.

4. Once your application and documents are submitted, a Financial Navigator will review your application and determine your eligibility. They will contact you with an update on your application status.