Good Samaritan Plan
Cooperative Health’s Sliding Fee Discount Program
Cooperative Health ensures that no patient will be denied access to health services due to their inability to pay. All patients whether insured, uninsured, or underinsured may apply. The Good Samaritan Plan can help with the cost of medical visits, lab work, procedures, and immunizations. If you need assistance with your insurance deductible, co-insurance or co-pay, this program may assist you.
Our sliding-fee program allows us to reduce and discount the fees for the care of you or your family. Eligibility is based on annual family income and household size.
Applying is easy. Applicants must:
- Be 18 years of age or older to apply
- Complete an application
- Present a valid photo ID
- Provide proof of income if age 18 or older
- Provide proof of identity for all household members (spouse and dependents) listed on the application
Download sliding fee program forms here:
Bring the completed application along with the required documents to your appointment.
Applications are also available at any Cooperative Health practice. For questions or more information, call our billing office at (803) 799-5080, option 1.
Acceptable Documentation for Good Samaritan Plan / Sliding Fee Program
Note: Individuals over the age of 18 years old must provide a Photo ID
- Out-of-Country Driver’s License or Photo ID
- Consulate Card (undocumented)
- Resident/Green Card (resident card)
- Driver’s License or State-Issued Photo ID
- College ID
- Birth Certificate
- Social Security Card
- Shot Record
- Insurance Card
- Medicaid Approval Letter or Online Eligibility Print Out (Insurance)
- Social Security Approval Letter
The above documents are accepted by Cooperative Health only for the determination of eligibility for our Sliding Fee Program.
If not working:
- SSI/Disability Income Statement
- Child Support
- Public Assistance Award Letter
- Unemployment Statement (only if receiving weekly benefits)
- Student Grant/Scholarship Award Letter
- Declaration of Income
- Pay Stubs
- Employee Earning Statement
- Letter from Employer (on company letterhead, must include address and phone number)
- Tax Return, 1040 or 1099
- Declaration of Income (if working and paid in cash)