Fees & Discounts

Dental

Sliding Fee Discounts

Sliding fee discounts make care affordable for patients without insurance, as well as patients who are underinsured (e.g., those with high-deductible plans).

Enter the number of people who live in your house, plus your household's monthly or yearly income to see what discount you may qualify for. Income includes all sources of income of all adults ages 18+ who live in your household (before taxes are deducted). 

*This tool is for estimates only and does not guarantee eligibility. 

‍ How to apply ‍

  • Complete Open Door's income screening form, available at any Open Door location. Or print/download the form in English or Spanish. 

  • Turn in the income screening form and proof of income for every adult (age 18+) in your household. Proof of income must show 30 days in a row. You can bring copies in person to any Open Door location or email copies to billing@opendoorhs.org. 

  • If you get money help from family or friend, use the verification of income form, available at any Open Door location. Or print/download the form in English or Spanish.   

  • If you have no income, complete the wage inquiry form, available at any Open Door location.

  • Questions? Call (765) 286-7000 (select Billing), email billing@opendoorhs.org, or stop by the front desk at any Open Door location.

    • Employment check stubs last 30 days

    • W2 and/or 1099 Tax form through April only (Unless self employed)

    • Unemployment check or print-out

    • Child Support/Alimony computer print-out

    • TANF copy of documents from FSSA

    • SSI or Disability check stub or bank statement

    • Social Security check stub or bank statement

    • Pension or Retirement statement of benefits from previous employer, bank or investment firm

    • Trust/Endowment bank statement

    • Scholarship/Grant letter of award

    • Union Sub Pay check stub

    • Personal help, in case of no income letter from person providing support

Nominal fee

For all discount levels, a nominal fee is due at time of service. Discounts do not apply to the nominal fee. Your nominal fee is applied to the total amount of visit fees you owe after any discounts. In some cases, the nominal fee will cover all charges owed (e.g., for someone whose visit is discounted at the 100% level). If your visit fee after discounts is more than your nominal fee, the nominal fee counts as a credit toward the remaining costs; you are then responsible for remaining cost after the nominal fee is applied.

  • Example A:
    A patient falls into discount category A, and they pay a $50 nominal fee at time of service. Their discount is 100%. Based on the services they received, their visit fee without a discount would have been $149. Because their discount is 100%, their visit fee is $0. They paid their $50 nominal fee and owe nothing more.

  • Example B:
    A patient falls into discount category B, and they pay a $55 nominal fee at time of service. Their discount is 60%. Based on the services they received, their visit fee without a discount would have been $200. Because their discount is 60%, their visit fee is $80. They have already paid the $55 nominal fee at time of service, which is applied to the amount of the visit fee. They owe the remaining $25. This can be paid at time of service or billed to the patient. Patients with financial barriers may set up payment plans for amounts owed.

Fees & Discounts: General Medical | Family Planning | Urgent Care | Chiropractic