Whether or not you have health insurance, Terry Reilly patients may be able to reduce costs through our Sliding-Fee Discount Program. Once approved for a discount, the amount you pay is based on family size and verified income.
Typically, this is you, your spouse and your children. Gather required forms of income verification. Submit completed application and required verification forms. Completed applications with income verification take up to 3 business days for processing. Our front desk staff and patient navigators are always available to help you through this process. We speak Spanish! Phone: Advisory: Application becomes void if income verification is not supplied within 30 days of signing.
Patient will be charged full fees until a new form is completed and income eligibility is determined. My application is complete. I want to submit verification forms only. Download a printable application. Income type. If you are employed:. If you are self-employed:. If you are paid in cash:. Do you receive other assistance such as?
Social Security. Supplemental Income SSI. Rental property income. Trust or estate funds. Child Support. You will need. Bank statement with 30 days of history. If you have no household income:.
Further verification is required. In Person: Return completed application and required verification forms at any Terry Reilly location. By Mail: 16th Ave. North, Nampa ID Please mail document copies only. Originals will not be returned. Through MyChart: This option allows secure electronic submission of income verification documents only. Click here for step-by-step instruction.
