There are two steps to determining safety net dental clinic patient charges: (1) establishing a non-discounted (full) fee schedule, which should reflect the usual fees charged by private dentists in the community and (2) developing a sliding fee schedule of percentage discounts.

Full Fee Schedules

Your full fee schedule should approximate prevailing rates in the private sector. You will foster access by reducing charges through your sliding fee schedule rather than through full fees. There are several sources of patient fee data available for purchase, although they summarize data over large geographic regions, such as multiple states, so the fees may not be accurate for a specific community. Resources include the American Dental Association (ADA), dental trade journals,and private fee survey companies.

Sliding Fee Schedules

A sliding fee schedule is a mechanism for discounting fees in accordance with the patient’s ability to pay for care. The patient’s relative level of financial need is usually determined using the federal poverty level (FPL), which is determined annually and published in the Federal Register.

Table 1 is based on the 2011 FPL and uses arbitrary discount levels and family annual income intervals. Clinics may have discretion in determining discount levels and family income intervals, in effect judging a patient’s ability to pay. Because many safety net dental clinic patients qualify for the minimum payment, deciding what the minimum payment will be is important to clinic sustainability.

Table 1: Discounts Based on Family Size and Income Level

How to use Table 1:

1. Find the number of family members in the first column.
2. Go across the line and find the number closest to, but not greater than, the responsible party’s gross annual income.
3. Go down that column to the last line to find the percentage discount to apply to full fees.

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