At Rural Health Group, excellent patient care is our first priority. In order to better serve our new patients we have posted new patient packets for both our medical and dental practices. By filling out these packets in advance and presenting them at the time of your appointment, you can significantly reduce the amount of time you spend in the waiting room. Plus, it’s always more convenient and accurate when you do not feel rushed to fill out the information.
Click on the appropriate link below to download the new patient packet. Print it out, fill it out, and bring it in.
MEDICAL and DENTAL – New patient packet
- Patient AgreementOpens a new window
- Acuerdo del pacienteOpens a new window
- Notice of Privacy Practices Opens a new window
- Notificación de Prácticas de PrivacidadOpens a new window
- Sliding Fee ApplicationOpens a new window
- Verificación de Ingresos (Para Tarifa de Descuento)Opens a new window
- Income AssessmentOpens a new window
- Evaluación de ingresosOpens a new window
Paying for Your Visit
Payment options include:
Cash, Checks, Visa, MasterCard, Discover and American Express.
Care Credit (Dental and Women’s Health).
Payment(s) can be made electronically via the Patient Portal.
Rural Health Group is not a “free clinic” – however, our services are available at a deeply reduced fee to those who qualify based upon household size and income. If you qualify for the “Sliding Fee” scale, we will not deny service due to inability to pay.
If you have trouble paying for your health care due to your financial situation, please read the section below about our Sliding Fee Program and contact your local clinic for questions.
Sliding Fee Program
Rural Health Group believes that access to health care is a fundamental right that should not be limited by an individual’s ability to pay. Rural Health Group receives modest federal support to provide care to people with limited financial means. It is the intent and purpose of Rural Health Group Inc.’s sliding fee program to guarantee that all patients have access to quality medical care, regardless of their ability to pay for such services. Inability to pay is explicitly defined as those patients with annual household income of 200% and below the federal poverty level.
Individuals with annual household income greater than 200% of the federal poverty level are considered ABLE to pay, and RHG may deny services for individuals earning more than 200% of federal poverty for non-payment.
Rural Health Group’s sliding fee program is the payer of LAST resort. As such, if a patient qualifies for Medicaid the patient is ineligible for Sliding Fee. Children aged 18 and younger and adults with dependent children must have a current application letter or other documentation from the county Department of Social Services proving the patient has applied for Medicaid before being eligible to apply for the sliding fee discount. If the patient is undocumented (no valid social security number), the Medicaid application letter is NOT required.
Patients will qualify for sliding fee discounts based on household size and income. Eligibility is extended to all patients, regardless of other medical coverage, with the exception of NC Medicaid. (Patients with Medicaid coverage for Part B Medicare premiums may be screened for sliding fee).
Patients can be insured and still qualify for sliding fee. Oftentimes we have patients with limited financial means who have Medicare or private insurance, but these individuals face barriers to paying co-payments, co-insurance, etc. Any insured patient who is having a hard time paying for medical services will be screened for sliding fee based on eligibility requirement size of house hold income and size.
RHG will courtesy bill all insurance companies and plans. As a service to our patients, RHG allows insurance companies 60 days to render payment. After 60 days, the patient is responsible for the entire balance and it will be due in full before being seen again. Sliding fee medical patients will not be denied care due to inability to pay outstanding balances.