Northwest Health Service clinics are open to patients with and without insurance. We accept most insurance and will either file claims for you or help with the completion of claims when needed. Uninsured patients are asked to complete a 2011 Discount Program Application prior to service. Costs will be determined based on household size and income.
About the Discount Program Application
The Discount Program application will help determine the cost for service based on household size and income.
Northwest Health Services fees are based on a discount program which includes medical, dental, behavioral health and pharmacy services and is made possible through grant funding.
Please click on the boxes below to see the discount charts.
Medical & Behavioral Health
| < 100% of Poverty Level | 100-150% of Poverty Level | 151-200% of Poverty Level | > 200% | ||
|---|---|---|---|---|---|
| Adults: Copay $25 (Below 19 yr/Copay$0) |
Copay $35.00 | Copay $45.00 | Patient Pays 100% | ||
| Poverty Level | Family Size | SF Plan A | SF Plan B | SF Plan C | |
| 10,830 | 1 | 0 to 10,830 | 10,831 to 16,245 | 16,246 21,660 | Over 21,661 |
| 14,570 | 2 | 0 to 14,570 | 14,571 to 21,855 | 21,856 29,140 | Over 29,141 |
| 18,310 | 3 | 0 to 18,310 | 18,311 to 27,465 | 27,466 36,620 | Over 36,621 |
| 22,050 | 4 | 0 to 22,050 | 22,051 to 33,075 | 33,076 44,100 | Over 44,101 |
| 25,790 | 5 | 0 to 25,790 | 25,791 to 38,685 | 38,686 51,580 | Over 51,581 |
| 29,530 | 6 | 0 to 29,530 | 29,531 to 44,295 | 44,296 59,060 | Over 59,061 |
| 33,270 | 7 | 0 to 33,270 | 33,271 49,905 | 49,906 66,540 | Over 66,541 |
| 37,010 | 8* | 0 to 37,010 | 37,011 55,515 | 55,516 74,020 | Over 74,021 |
* For family units with more than 8 members, add $3,740 for each additional member
Discounted fees are contingent upon proof of income and cannot be authorized without such proof. Completed income tax returns are the preferred acceptable proof of income. Any variances from this policy must be approved by the discount program Specialist in advance.
Pharmacy
| < 100-200% of Poverty Level | > 200% of Poverty Level | ||
|---|---|---|---|
| Cost + $11.00 Dispensing Fee | Patient Pays 100% | ||
| POVERTY LEVEL | Family Size | SFS A, B, C | |
| 10,830 | 1 | 0 to 21,660 | Over 21,661 |
| 14,570 | 2 | 0 to 29,140 | Over 29,141 |
| 18,310 | 3 | 0 to 36,620 | Over 36,621 |
| 22,050 | 4 | 0 to 44,100 | Over 44,101 |
| 25,790 | 5 | 0 to 51,580 | Over 51,581 |
| 29,530 | 6 | 0 to 59,060 | Over 59,061 |
| 33,270 | 7 | 0 to 66,540 | Over 66,541 |
| 37,010 | 8* | 0 to 74,020 | Over 74,021 |
For family units with more than 8 members, add $3,740 for each additional member.
Discounted fees are contingent upon proof of income and cannot be authorized without such proof. Completed income tax returns are the preferred acceptable proof of income. Any variances from this policy must be approved by the discount program Specialist in advance.
Discount program PATIENTS PAY: Prescription Cost + $11 Dispensing Fee Only
Dental
| < 100% of Poverty Level | 100-150% of Poverty Level | 151-200% of Poverty Level | > 200% | ||
|---|---|---|---|---|---|
| Below 19 yr/Copay $0 | Patient Pays 100% | ||||
| POVERTY LEVEL | Family Size | SFS A | SFS B | SFS C | |
| 10,830 | 1 | 0 to 10, 830 | 10,831 16,245 | 16,246 21,660 | Over 21,661 |
| 14,570 | 2 | 0 to 14,570 | 14,571 21,855 | 21.856 29,140 | Over 29,141 |
| 18,310 | 3 | 0 to 18,310 | 18,311 27,465 | 27,466 36,620 | Over 36,621 |
| 22,050 | 4 | 0 to 22,050 | 22,051 33,075 | 33,076 44,100 | Over 44,101 |
| 25,790 | 5 | 0 to 25,790 | 25,791 38,685 | 38,686 51,580 | Over 51,581 |
| 29,530 | 6 | 0 to 29,530 | 29,531 44,295 | 44,296 59,060 | Over 59,061 |
| 33,270 | 7 | 0 to 33,270 | 33,271 49,905 | 49,906 66,540 | Over 66,541 |
| 37,010 | 8* | 0 to 37,010 | 37,011 55,515 | 55,516 74,020 | Over 74,021 |
* For family units with more than 8 members, add $3,740 for each additional member.
RAISE Clinic patients are eligible to receive dental services up to $1,000 per year without copay. After reaching services that total $1,000 RAISE Clinic patients who choose to continue to receive dental services, will be expected to pay applicable copay at the time of service. Copay does not apply for HOME Unit patients who are 100% of poverty or below for dental services provided at HOME Unit.
Discounted fees are contingent upon proof of income and cannot be authorized without such proof. Completed income tax returns are the preferred acceptable proof of income. Any variances from this policy must be approved by the discount program Specialist in advance.
COPAY AMOUNTS FOR BASIC DENTAL SERVICES ARE AS FOLLOWS:
- SFS A = $20
- SFS B = $30
- SFS C = $40
BASIC SERVICES INCLUDE:
- Diagnostic Exams X-rays Cleaning + Filling; Tooth Removal
- $20, $30 or $40 Copay + Copay applies for each tooth treated
COPAY AMOUNTS FOR DENTURES:
- $400 - $600 each upper and lower denture

Northwest Health Services provides care to children and adults in the Missouri counties. Services vary by location. Find the Northwest Health Services provider near you.
Our staff is ready to assist you and schedule your next appointment. Are you a new patient? We have all the necessary forms available online so you can complete them before you arrive allowing us to process your information right away.
Northwest Health Services has been serving communities in Missouri for over 25 years. We’re proud to be a non-profit, community-owned organization.