Thank you for choosing Moscow Medical as your healthcare provider. We are committed to building a successful physician-patient relationship with you and your family. Clearly understanding our Financial Policy is important to our professional relationship. Please call (208) 882-7565 if you have questions about our fees, our policies, or your responsibilities. It is your responsibility to notify our office of any patient information changes.

It is Moscow Medical’s policy to provide health care services, regardless of the patient’s ability to pay. Our discounted services are based on family income and household size. Moscow Medical will not discriminate on the basis of age, gender, race, color, creed, sexual orientation, gender identity, religion, disability or national origin. In addition, Moscow Medical does not discriminate based on the individual’s ability to pay, or whether payment for the service would be made with Medicare, Medicaid or CHIP.

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Payment or other arrangements, such as use of the sliding fee scale detailed below, is expected at the time of your visit. We will accept cash, check, or credit card. Payment will include any unmet deductible, co-insurance, co-payment amount, or non-covered charges from your insurance company. If you do not carry insurance, payment is expected in full at the time of service.


Insurance is a contract between you and your insurance company. We will bill your primary insurance company as a courtesy to you. In order to properly bill your insurance company we require that you disclose all insurance information. Failure to provide complete insurance information may result in patient responsibility for the entire bill. Although we may estimate what your insurance company may pay, it is the insurance company that makes the final determination of your eligibility and benefits. If your insurance company is not contracted with us, you agree to pay any portion of the charges not covered by insurance, including but not limited to those charges above the usual and customary allowance. If we are out of network for your insurance company and your insurance pays you directly, you are responsible for payment and agree to forward the payment to us immediately. We are contracted with most insurances. We recommend you verify with your insurance carrier if Moscow Medical is in-network.

Self Pay

Self pay accounts are patients without insurance coverage, patients covered by insurance plans in which the clinic does not participate. Self-pay patients are required to pay in full at time of service, unless prior payments arrangements have been made.

Sliding Fee Scale

The purpose of the Sliding Fee Scale Program (SFS) is to provide health care services regardless of the patient’s inability to pay.

Moscow Medical offers discounted services based on family income and household size. Moscow Medical does not discriminate on the basis of age, color, disability, gender identity, national origin, race, religion, or sexual orientation. In addition, Moscow Medical does not discriminate based on payment type for services, whether through Medicare, Medicaid, CHIP, or any other payment method.

Applications for our discounted services can be requested at the front desk or by contacting the billing office. In order to determine individual eligibility the patient/guarantor must complete the Sliding Fee Scale application and provide the supporting documentation prior to services being rendered.

Proof of Income

  • Tax returns (two years)
  • Pay stubs (last 90 days)
  • Recent correspondence from Medicaid (if patient has applied for Medicaid assistance and has been denied) or other state-funded assistance programs
  • Any other proof of income (child support, SSI, disability, etc.)

Eligibility Requirements

  • Eligibility is based on income and size of household
  • Letter of denial from Medicaid (required)
  • SFS application and supporting income documentation
  • Only medically necessary services are eligible for the purpose of this program; services not deemed medically necessary (i.e. patient forms) are excluded from financial assistance
  • All completed and signed documents must be provided within 10 business days of application date or application will be denied

Eligibility Period

  • Patient that qualifies for the SFS program will receive reduced cost services for six months,
  • starting on the date of approval (cannot back date)
  • The patient’s account will never permanently be designated for discounted services
  • Once the six-month term has ended, the patient will need to reapply and provide new income information

Auto and Workman’s Compensation Claims

It is the responsibility of the patient to provide our office with all the authorization forms and claim numbers. We will attempt to bill the insurance, if the claim is denied patient will be responsible for payment in full. Patients must be established with our clinic. We do not third party bill. If your injury is covered under Washington Labor and Industry, we cannot see you for this injury.

Other Services Requiring Payment

  • Laboratory services are billed separately by LabCorp. A LabCorp representative can be reached at (800) 598-3345.
  • Fees for the completion of forms for services performed outside of an office visit, such as FMLA, L&I and physicals are $25 for the first page and $5 for each additional page.
  • You may request a copy of chart notes for $1.09 for the first 30 pages and $0.82 for each additional page.
  • Moscow Medical will assess a $40 fee for returned checks and non-sufficient funds (NSF).