Fairfax Medical Facilities, Inc. accepts Medicare, Medicaid, SoonerCare, and most types of health insurance. If you do not have health insurance, your fees for services are based on a sliding fee scale if you are deemed eligible. We want everyone that needs services to be able to receive them regardless of your ability to pay.
2022 Sliding Fee Scale Application Download (English)
2022 Sliding Fee Scale Application Download (Spanish)
*For Families / households with more than 8 persons, add $4,720 for each additional person.
HOW TO READ THE SCALE
Step 1: Locate the row corresponding to the number of individuals in your family.
Step 2: Move to the right until you find the range containing your average annual income.
Step 3: Go to the top of that column. The percentage shown is the portion of the bill you will pay.
* You Must Provide Proof of Income by presenting at least one of the items listed below
- Tax Forms from the most recent year
- Paycheck stubs for three months with year to date income provided
- Fixed income statement (example: pension, social security or all eligible on all eligible bank statements showing deposits)
- Signed notarized letter from, example: Minister, Law enforcement, City hall or Lawyer verifying financial status, housing situation, and how you cover expenses.
- Student grant information
- If you are self-employed, tax forms from current year and a profit/loss statement.
* You must provide proof of address by presenting at least one of the items listed below
- Required-Drivers license or state issued ID card
- Utility bill
REMEMBER All family income is to be included. Income is the AMOUNT EARNED BEFORE TAXES ARE DEDUCTED.