Make an Appointment: (336) 283-2510 |   [email protected]

Sliding Scale Information

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From the beginning, the mission of Achieving Changes Counseling has been to provide the highest quality services to those struggling with issues related to mental illness regardless of ability to pay. To provide some organization and structure to this aspect of our mission, we have adopted the Sliding Scale Fee Discount Program. 

The Sliding Scale Fee Discount Program was created to ensure that mental health services are available and accessible to uninsured and underinsured clients by providing an affordable fee structure that is in accordance with federal regulations.

Eligibility for the Sliding Scale Fee Discount

Any individual may apply for the Sliding Scale Fee Discount; however, eligibility in the program is based on the household annual income and family size. Only individuals living in households with income below 500% of the Federal Poverty Level may qualify for a Sliding Scale Fee discount. 

The Sliding Scale Fee Discount is only available to individuals and families who are uninsured or under-insured.

As part of the intake process, if an individual is uninsured, the individual will be informed of the availability of the Sliding Scale Fee Discount and explain the paperwork needed to complete the application.

Applying for the Sliding Scale Fee Discount

There are 3 major steps in applying for the Sliding Scale Fee Discount.

1.Download the Sliding Scale Fee Application or contact our office to have a copy emailed to you. You can go directly to the application by selecting here.

2.Individuals interested in applying for the discount must provide evidence of their financial status. Applicants have 2 weeks to provide information on income status. After that time, the application is considered denied. A new application may be resubmitted once the income verification materials are provided. 

Income status can be verified by 2 of the following forms of written verification of household income and size:

·      Paycheck stub (most recent)

·      W-2 form

·      Last Income Tax Return

·      Written statement from employer

·      Unemployment check stub

·      Social security check stub

3.Applications should be emailed, faxed or mailed to our office manager.

Email: [email protected]

Fax: 336-776-0091

Mailing Address: Achieving Changes Counseling Services, PLLC

P.O. Box 1417

Clemmons, NC 27012

Application Review Process

Once the application is reviewed, you will be contacted by Achieving Changes in writing of the discount granted, which will remain valid for 6 months, and the expected amount you will be required to pay for your treatment.

If the application is denied, the reason for the denial will be included in the written decision regarding the application.

Once notified of the decision regarding the Sliding Scale Fee Discount Application, you must immediately let Achieving Changes know if you intend to continue your treatment and how you intend to pay the fees for services.  

If you do not contact Achieving Changes within 2 weeks of notification of a Sliding Scale Fee Discount, the discount will be declined and you may reapply for the Sliding Scale Fee Discount in 90 days.

The Fine Print

By signing the application, persons authorize Achieving Changes Counseling Service, PLLC access in confirming income as disclosed on the application form.

Providing false information on a Sliding Fee Discount Program Application will result in all Sliding Fee Discount Program discounts being revoked and the full balance of the account(s) restored and payable immediately.

Sliding Fee Discount Program applications cover services rendered for a period of 6 months after the approved date, unless their financial situation changes significantly.

The applicant has the option to reapply after 6 months have expired or anytime there has been a significant change in family income.