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Our fees are greatly
reduced and offered on a sliding scale according to income.
Proof of Income Requirement
Though the Douglas County Dental Clinic
provides dental services at a reduced rate, the services are not free.
In order to serve all of our patients better, proof of income is a
requirement to be treated here. Proof of income can be shown using:
- Check stubs from work
- Copy of last year’s tax form
- Copy of your vision card
- Copy of benefits received (Social
Security, unemployment benefits, etc.)
If you are unsure that your proof of
income will qualify you for services, please give us a call at
785-312-7770 to discuss your situation.
If you are relying on a third party to
pay for these services, they must meet the federal poverty guidelines
and they must provide proof of income from the list above.
All fees are due at the
time of treatment. Patients with unpaid
bills will not be seen for additional treatments until past due bills are
paid.
In order to be seen here, you must meet
our income guidelines. Starting in 2010, we are able to see
patients that are at 250% of 2008 federal poverty guidelines as
determined by the State of Kansas' SCHIP guidelines. Our income
guidelines are as follows:
|
# of people in household |
Fee Level 1 |
Fee Level 2 |
Fee Level 3 |
Fee Level 4 |
|
1 |
$10,830/year or $903/month |
$16,244/year or $1,353/month |
$21,659/year or $1,804/month |
$26,000/year or $2,167/month |
|
2 |
$14,570/year or $1,214/month |
$21,854/year or $1,820/month |
$29,139/year or $2,427/month |
$35,000/year or $2,917/month |
|
3 |
$18,310/year or $1,526/month |
$27,464/year or $2,288/month |
$36,619/year or $3,051/month |
$44,000/year or $3,667/month |
|
4 |
$22,050/year or $1,838/month |
$33,074/year or $2,755/month |
$44,099/year or $3,674/month |
$53,000/year or $4,417/month |
|
5 |
$25,790/year or $2,149/month |
$38,684/year or $3,223/month |
$51,579/year or $4,297/month |
$62,000/year or $5,167/month |
|
6 |
$29,530/year or $2,461/month |
$44,294/year or $3,690/month |
$59,059/year or $4,921/month |
$71,000/year or $5,917/month |
|
7 |
$33,270/year or $2,773/month |
$49,904/year or $4,158/month |
$66,539/year or $5,544/month |
$80,000/year or $6,667/month |
|
8 |
$37,010/year or $3,084/month |
$55,514/year or $4,625/month |
$74,019/year or $6,167/month |
$89,000/year or $7,417/month |
For family units with more
than 8 members, add $3,740, $5,610, $7,480, or $9,000 for each additional member. |
