No patient is denied services due to an inability to pay

Our Financial Services staff works to find the most affordable options for your family. Mountain Park’s Sliding Fee Discount Program is just one of them. We work directly with state and federal programs as well as Arizona Medicaid. Call (602) 243-7277 to make an appointment.

 


What to Bring

During your appointment with Mountain Park’s Financial Services team, we will help find the best programs for you. Our team members will ask several questions to discover what you and your family are eligible for. Please be assured that all responses will be kept completely confidential.

Discounted/sliding fees are based upon federal poverty guidelines, and patient eligibility is determined by annual income and family size. Schedules are established and implemented to ensure that a non-discriminatory, uniform, and reasonable charge is consistently and evenly applied.

For more information, visit the Arizona Department of Health Services website.

Patients are required by law to provide documentation in order to determine eligibility for AHCCCS and Mountain Park’s Sliding Fee program. For every member in your family, provide as many of the following documents (one per category) as you have available:


1. Proof of Identity

  • Any legal government issued identification for all adults
  • A valid Arizona Drivers license or Arizona identification card
  • Social security cards for everyone in the family
  • Passport
  • Residence Alien ID card
  • Naturalized Citizen Certificate

2. Proof of Age

  • Birth certificates for everyone in the family
  • Legal documents proving guardianship for children who are in your custody

3. Verification of Residence

(must display your name and address and must be dated within the last 30 days)

  • Current utility bill (telephone, electricity, water, gas)
  • Proof of rent/mortgage with complete address
  • Mail envelope showing U.S. postal marking
  • Letter from non-relative neighbor stating your complete address. Letter needs to include the neighbor’s complete address, telephone number, signature and date.
  • If you reside with someone else, please bring a letter with address, date and signature from that person along with his/her utility bill and their contact phone number, as well as some legal form of correspondence you have received at that address

4. Earned Income

  • Pay stub(s) for the last month for husband and wife or head of household (4 weekly stubs, 2 bi-weekly stubs, or 1 monthly stub) OR
  • Letterhead statement from employer stating the following:
  • Employer’s name, address and phone number (signed and dated)
  • Exact income for the last 30 days
  • 30 Day record of earnings if paid in cash; gross income with work expenses
  • If you are self employed a copy of your 1040 Tax Return for current year

5. Unearned Income

  • Unemployment check stubs (4 weekly stubs)
  • Child support or Alimony
  • Public assistance letter if receiving (AFDC, general assistance, Social Security award letter etc.), most recent or last 30 days
  • Proof of money you receive from any source
  • A letter from the person that is supporting you (it must include their address, phone number, signature, and date)
  • School grants

6. Proof of Medical Insurance, if any

  • Any insurance cards, AHCCCS cards, and/or Medicare cards

7. Proof of Pregnancy-With Estimated Date of Delivery

  • If you are pregnant and do not have a doctor’s verification Mountain Park can assist you with access to a doctor.

If you have any questions about what to bring to your appointment please call (602) 243-7277.