Sliding Scale Fee Discount Program
From the beginning, the mission of Complete Wellness has been to provide the highest quality services to those struggling with issues related to mental illness regardless of ability to pay. To provide some organization and structure to this aspect of our mission, we have adopted the Sliding Scale Fee Discount Program.
The Sliding Scale Fee Discount Program was created to ensure that comprehensive mental health services are available and accessible to uninsured and underinsursed patients by providing an affordable fee structure that is in accordance with federal regulations.
Eligibility for the Sliding Scale Fee Discount
Any individual may apply for the Sliding Scale Fee Discount; however, eligibility in the program is based on the household annual income and family size. Only individuals living in households with income below 450% of the Federal Poverty Level may qualify for a Sliding Scale Fee discount.
The Sliding Scale Fee Discount is only available to individuals and families who are uninsured or under-insured.
As part of the intake process, if an individual is uninsured, the individual will be informed of the availability of the Sliding Scale Fee Discount and explain the paperwork needed to complete the application.
Applying for the Sliding Scale Fee Discount
There are 3 major steps in applying for the Sliding Scale Fee Disc
Download the Sliding Scale Fee Application. You can go directly to the application document by selecting this button:
All Steps Must Be Completed for Consideration
1.
Individuals interested in applying for the discount must provide evidence of their financial status. Applicants have 2 weeks to provide information on income status. After that time, the application is considered denied. A new application may be resubmitted once the income verification materials are provided.
Income status can be verified by 2 of the following forms of written verification of household income and size:
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Paycheck stub (most recent)
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W-2 form
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Last Income Tax Return
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Written statement from employer
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Unemployment check stub
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Social security check stub
In some cases, an individual is unable to provide proof of income. The Self-Declaration of Income must be completed as an alternative. For information on the Self-Declaration form, please select this button:
2.
3.
Applications must be emailed to Office@CompleteW.com or mailed through the postal system to:
Complete Wellness
Attention: SSF
10 West Madison Street #11
Baltimore, MD 21201
Sliding Scale Fee Discount Application
To apply for the Sliding Scale Fee Discount, you must first complete the application. The application is available at the Complete Wellness offices or you may download the application by selecting this button.
The application must be completed in its entirety in order to be consider for eligibility.
Self-Declaration of Income Form
Complete Wellness recognizes that some forms m