Ability to Pay Program

To qualify for the ATP Program, total income must be at 200% or below the current Federal Poverty Guidelines (FPG). Proof of ineligibility for Medi-Cal may also be required. A signed self-declaration provides provisional approval; applicants then have ten business days to submit a completed program application in conjunction with required verifications as indicated on the Documentation Checklist.

Office visit charges and other clinic services are based on family household size and income level. For qualifying individuals/families living at or below 200% of current FPG, a medical office visit charge will range from $20 to $55, depending on ATP Tier. Procedures and other services may also be discounted, depending on ATP Tier.

The ATP Tier determines a participant’s office visit costs and the discount that will be applied to other charges, including procedure, laboratory, and radiology services. Patients have a provisional 30 day intial approval to gather financial information and complete the application.

Following application verification, staff will provide you with office visit cost information, as well as discount rates for other services. Please remember that these charges may be subject to changes imposed by federal directives or County policy.

Once verified, an approved application typically qualifies for one full year of ATP participation.

The self-declaration form provides provisional approval for one discounted office visit. Verification should be completed within ten business days or you may be required to pay the full cost of your next office visit. The full cost of an office visit, with no additional services, typically ranges from $118 to more than $200.

For self-pay patients who do not qualify for the ATP Program, an office visit charge to see a medical care provider is $72 if paid in full on the date of service; however, this does not include other procedures and services. If not paid in full on the date of service, typical office visit costs can range from $50-$452.

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