Paying for Services


One or more of the following items, plus the completed Sliding Fee Scale application, must be submitted for consideration:

  • A copy of current year's Income Tax Return
  • Copies of all paystubs from a one month period
  • A copy of one month's bank statement indicating direct deposits from income sources
  • A letter from employer verifying, hourly wages, number of hours scheduled on a regular basis, signed by the employer on their letterhead
  • Notice of Financial Determination from the Office of Unemployment Compensation
  • Notice of Income Determination from the Department of Housing

River Valley Health and Dental Center requires payment at the time of service. We have a sliding fee scale discount program that provides cash discounts to those individuals who qualify. (See the links below for the discount information). If you think you may be eligible for a sliding fee discount, please provide us with the information according to the list below, prior to your appointment, in order to determine your eligibility:

We strongly encourage you to apply for Medical Assistance through the Department of Public Welfare, as a first step, in order to shorten the screening and eligibility process.

As an FQHC, we provide services regardless of ability to pay and require the completion of eligibility screening before discounts are applied. Payments, including discounted payments, are required at the time of service. Please contact us, should you be unable to pay for services at the time of service, and we will assist you in determining eligibility for discounts and establishing a plan for payment. Co-pays are due at the time of service. Co-pays are subject to the sliding fee discount program. If you feel you may be eligible for a co-pay discount, please contact us prior to your appointment.

Because RVH&DC depends on revenue from our patient care services to keep our doors open, we maintain appropriate billing and collections mechanisms to collect payments due to us. If you have questions about this or feel you are exempt from payment, please contact us prior to your next appointment.