Enrollment Appointment Information

No appointment necessary at our Pecos, Westminster, Lafayette, Thornton, or Peoples Clinics. Please walk in between the following hours:

Mondays – Thursdays: 8am-11am and 1pm-4pm
Fridays – 8am-11am and 1:30pm-3:30pm

If you would prefer to schedule an appointment, please click here or call 303-650-4460.

 

What Documents Will You Need to Apply for Financial Assistance?

Bring all necessary documents to your appointment. We will not be able to help determine what financial assistance you qualify for if you do not bring the necessary documents. If you cannot bring one or more of the documents, please cancel your appointment and reschedule once you have all the documentation.

• Picture ID for all adult applicants.
• Social Security numbers for all family members (if applicable).
• Legal Permanent Resident Card if resident of U.S., or work permit (if applicable).
• Proof of address under patient’s name such as public service bills or other bills. Statement date should be for previous or current month.
• Insurance cards, for example: Medicaid, Medicare or private health insurance, etc.
• Proof of unearned income, for example: child support, SSDI, SSI, or unemployment letter.
• If self-employed, bring previous month business ledger. The ledger needs to reflect total earning for the month and total business expenses for the same month.
• If pregnant, need to know expected delivery date. Bring picture ID or birth Certificate and Social Security card (if applicable).
• Children under age 18: Passport, birth certificates, Colorado ID or school ID (if applicable).
• If paid with check stubs, all check stubs from previous month. If you are paid with cash please provide a signed and dated letter from your employer. Letter needs to state the hours worked per week, pay per hour, pay frequency and gross income from the last month. Make sure your employer listed his/her phone number and business address.
• If shared residency: Bring a signed, dated letter from the person you live with. The letter should include the person’s name, address and, phone number. You will also need to bring a bill dated the previous or current month from the person writing the letter.

You Deserve Transparency

Beginning Jan. 1, 2022, we will offer cost estimates (also called Good Faith Estimates) to any patient who is on a self-pay program or who is uninsured.

We want you to know what your health care will cost.

For more information, please contact a member of our Billing Department.

 

GOOD FAITH ESTIMATES FAQs

What is the new requirement?

Beginning on Jan. 1, 2022, all community health centers and most other health care providers must give all uninsured or self-pay patients an estimate of the cost of their care prior to their appointment. This mandate comes from the federal No Surprises Act, which was passed in December 2020. These cost estimates, also called Good Faith Estimates (GFEs), summarize a patient’s total out-of-pocket expenses for the care they will receive at the specified appointment. GFEs must be provided to qualifying patients who schedule an appointment at least three business days in advance or to any patient specifically requesting a GFE.

 

Are GFEs optional?

Patients cannot opt out of these estimates, and Clinica must provide them.

 

Which patients must be provided a GFE?

All uninsured and self-pay patients must be provided a GFE for their visit as long as they:

• Schedule an appointment for that service at least three business days in advance.
• Request a GFE (or otherwise ask about the costs of the service) even without scheduling an appointment.
• Have insurance but it does not cover the service they are seeking (e.g., they only have medical coverage but are inquiring about a dental service).
• Have a short-term, limited-duration plan.
• Are underinsured and indicate that they do not plan to submit a claim to their insurer but will pay for the service entirely out-of-pocket.

 

What information is included in the GFE?

A GFE must provide the following information:

• The primary service being provided to the patient during the visit or “period of care.”
• The items and/or services that are “reasonably expected” to be provided “in conjunction with the primary service” for which Clinica, or an outside provider, has a separate charge. For example, if a patient schedules an appointment for suspected strep throat, the GFE would include an office visit, a lab test (if there is a separate charge for that) and a generic medication.
• The exact charge for the service(s) the patient will be receiving related to the appointment.

 

The services listed on the GFE will be based on the information available at the time it is requested or generated. The GFE is not required to cover unanticipated care that is not reasonably expected or results from unforeseen events.

 

What is the “period of care” for a GFE?

In most cases, the “period of care” is a single day. However, if a patient receives a single service that requires returning to the clinic to receive full service (e.g., the two-dose HPV vaccine), then the period of care should encompass both dates. Also, if the patient will have lab work done on a different day and those services are scheduled by Clinica, then the period of care must include both dates.

 

What if the cost of an item or service is incorrect on my GFE?

Patients whose charges are more than $400 above the cost estimate can pursue a dispute resolution process to get their charges reduced. To pursue a dispute resolution, contact our Billing Department at (303)827-7102.

 

Will Clinica staff be required to ask me if I am uninsured or self-pay to determine if I should receive a GFE?

Yes. The new federal law requires that health care providers, or a member of their team, ask every person who schedules an appointment (or asks about the cost of their care) if they are:

• uninsured for that service
• are self-pay (they do not plan to submit a claim or their insurance doesn’t cover the service)

 

How will I receive my GFEs?

You will receive GFEs through the patient portal or by standard mail (US Postal System). All GFEs will be stored in the patient’s chart for six years for future reference.

 

Can I ask for a GFE during an appointment?

If you ask ask for a cost estimate at the time of service, you will be directed to Clinica’s Billing Department at (303)827-7102.

 

What if I have questions about my GFE?

If you have additional questions after receiving their GFE, you can contact the Billing Department at (303)827-7102.

 

Must costs for dental and vision services (e.g., dentures, glasses frames, lenses, etc.) be included in the GFE?

Yes. GFE rules apply to “items or services such as those related to dental health, vision, substance use disorders and mental health.”