There are at least two approaches to using sliding fee schedules: (1) totaling the full fees, multiplying by the discount factor, and subtracting to determine charges to the patient and (2) establishing multiple lists of fees-per-service, one for each discount level (e.g., 100%, 75%, 50%, 25%) and determining patient charges by adding the services provided from the appropriate fee schedule.

Clinics may identify specific fees that they will not discount or will only partially discount. For example, on a full upper denture with an $800 full patient fee (for which the clinic incurs a $250 lab fee), the patient may be charged the $250 lab fee, and the discount will be applied to the $550 balance. For a 50 percent sliding scale discount, the charge would be $250 + [($550 x .5)] = $525.

Two key questions relevant to the sliding fee schedule are (1) what is the minimum fee and (2) what is the policy for denying care owing to inability to pay. These questions are fundamental to achieving a balance between access and financial sustainability.

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