Sliding Fee Scale Program

To assist our patients with their healthcare needs, Wayne Memorial Community Health Centers (WMCHC) utilizes the federal Sliding Fee Scale program. The Sliding Fee Scale program will be granted to patients who meet the financial criteria under the federal poverty guidelines.
 

You may download a copy of the Sliding Fee Application by clicking on the link below:
 
Sliding_Fee_Application.pdf 
 

Please complete the application and return with the supporting documentation of income to:
 

Wayne Memorial Community Health Centers
Physician Billing: Sliding Fee Specialist
601 Park St.
Honesdale, PA 18431
 

Supporting documentation of income would consist of your most recent income tax return. If your income has changed significantly, since you filed your last tax return, please provide written documentation of your current income in the form of 2 months worth of paystubs or a current payroll print-out. Documentation that may also be requested would include a current statement of unemployment with the amount received monthly, as well as a social security statement showing the same, if that applies to your situation.
 

If you do not have insurance coverage and you have no income and fall below the poverty guidelines, you will be required to apply for Pennsylvania Medical Assistance prior to Sliding Fee approval. That determination will be made upon receipt of the application. You will be required to pay a minimum co-pay at each office while your application is pending.
 

You will be notified of the status of your application within 10 days of receipt of all income verification requested.

If you are approved for the programs, acceptance as a patient is valid at all of the following WMCHC sites: Behavioral Health Center; Honesdale Family Health Center; McAndrew Family Health Center; Northern Wayne Family Health Center; Pike County Family Health Center; Together For Health Dental Center; Waymart Family Health Center; Women’s Health Division Honesdale, Hamlin and Pike; Sean McVeigh, MD, FCCP; Honesdale Surgical Associates; Dr. Monika Pek, Pediatrics-Honesdale and Dr. Alexander Pinsky, Pediatrics-Carbondale.
 

Please call the Physician Billing Office at 570-253-8194 with any questions or concerns.
 

 
 
 
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