Financial Assistance
for Gifford Patients
Financial Assistance
for Gifford Patients
Embedded Files
for Gifford Patients
Financial assistance (in the form of a sliding scale discount) is available to Gifford patients for preventive dental care only. It applies to both adults and children who are patients at Gifford Health Care. Income verification will be required.
Financial assistance (in the form of a sliding scale discount) is available to Gifford patients for preventive dental care only. It applies to both adults and children who are patients at Gifford Health Care. Income verification will be required.
To obtain the application for financial assistance, please click on this link:
The Financial Assistance Application can be filled out digitally and immediately submitted by email. For this method, fill out the form on your computer, save the form to your computer and then attach the form to an email. Send it to: healthconnect@giffordhealthcare.org
The form may also be printed and filled out (or filled out and printed) and mailed to Gifford Health Care, PO Box 2000, Attn: Financial Assistance Coordinator, Randolph, VT 05060. Or the form may be dropped off to any Gifford Health Care location.
Gifford Health Care will determine if financial assistance has been approved and will issue a letter of determination. Once this letter is obtained, then the sliding scale would be applied to preventive services provided by HealthHUB.
Gifford's sliding scale financial assistance chart is based on household income and family size, using the Federal Poverty Guidelines (FPG) to determine eligibility and the amount of discount. The specific chart is available within the Gifford Sliding Fee Discount Financial Assistance Application. Patients without insurance who are eligible will not be charged more for medically necessary care than what is generally billed to insured patients, and the sliding scale discount is applied after a 50% discount on the AGB amount.
How it works
How it works
Eligibility: Based on household income and family size, determined by Modified Adjusted Gross Income (MAGI) and Federal Poverty Guidelines (FPG).
Application: You must complete the Gifford Sliding Fee Discount Financial Assistance Application and provide supporting documentation.
Discount calculation:
First, Gifford applies a 50% discount to the "Amount Generally Billed" (AGB) for insured patients to get a new balance.
Then, the sliding scale discount is applied to this new balance based on your income and family size. You may receive free care ($0) or a discount.
Application process:
Applications are typically approved within 30 days of submission.
Approved financial assistance is valid for 365 days, after which a new application is needed.
Important notes
Important notes
No assets considered: Your eligibility is based only on household income and family size, not on assets like your primary home, cars, or retirement accounts.
No extra collections: Gifford will not use extraordinary collection actions before determining your eligibility for financial assistance.
Appeal process: You have 30 days to appeal a decision by writing to the Chief Financial Officer.
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