Sliding Fee Policy

It is the policy of Brave Space Black Woman Will Bloom to provide quality medical care and behavioral health services to all persons in need of care, regardless of income and/or the inability to pay. Please complete the following information so that BWWB will be able to determine your eligibility for discounted services. You will be reassessed for the sliding scale every six months and you will be required to provide updated proof of income. 

 

BWWB offers discounted services to clients who are uninsured and have low income. As we do not accept insurance we offer discounted services to all clients for Coaching, and or Counseling The amount a client pays is based on the federal income levels. Each year the federal government sets a Federal Poverty Line (FPL) and new income levels that qualify patients for discounted care. The income levels are based on a patient’s gross income (how much money you make each year before taxes are taken out).

 

Once all documents have been reviewed, you will be informed of the sliding fee based on gross annual income and household size. 

 

How Do I Qualify?

To qualify for the BWWB charges, you must submit proof of your “household” gross annual income. A “household” includes legal children, a civil union partner or married spouse, and legal dependents. Annual gross income includes salary, unemployment benefits, disability or social security benefits, investment income or other sources of income that support the household. You should bring proof of all of the household income for yourself and everyone in your household.

The following documents can be used for proof of income:

• Most recent tax return

• 2-3 most recent pay stubs from employer, no older than three months

• Most recent W-2 or 1099
  (Prior year W2 or 1099 will not be accepted as Proof of Income after June 30 of the current year)

• Letter from employer stating cash earnings that is signed by your employer or supervisor

• Letter from the Social Security Administration documenting your SSI or SSDI benefits

• Letter from the Social Security Administration documenting that you are ineligible for government benefits

• Letter detailing unemployment benefits from your state unemployment office

• Military Leave and earnings statement

• Notarized letter stating you have no source of income signed by you

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