Your Cost

Payment, Health Insurance, & Financial Aid Information

Building Equitable Healthcare for All Texans

Prism Health North Texas believes every individual has the right to accessible health care and the opportunity to attain their highest level of health. Whether a patient has a low income, is uninsured, or is underinsured, there are programs available to make health care more affordable.

We accept most major health insurance plans, including Medicaid and Medicare. We can also help you enroll in health insurance plans through the Affordable Care Act marketplace.

Eligibility specialists are on hand to help guide you through the sliding payment fee rates, payment plans, and available programs. We are happy to discuss your options for meeting your financial responsibilities, and we will not refuse care based on your inability to pay.

Accepted Insurance Plans

Assistance Program Eligibility

Sliding Fee Rates

Billing & Payments

Accepted Health Insurance Plans

Below is a list of health insurance plans our health centers and dental clinics accept. We offer programs that help those underinsured or who need assistance with health insurance premium payments.

If you have questions or need more insurance information, please call 214-521-5191 to speak with a dedicated Insurance Verification Specialist.

Company	Plans
Aetna	EPO HMO PPO Prime Medicare Advantage
Aetna Better Health	CHIP HMO Medicaid STAR Medicaid
Ambetter	Ambetter Core
Amerigroup	HMO Medicare-Medicaid Plan STAR Medicaid
Baylor Scott & White Commercial	Medicare Advantage
Blue Cross Blue Shield	HMO Medicare Advantage POS PPO
Care N’ Care	HMO Medicare PPO
Cigna	HMO LocalPlus Medicare Advantage OA Plus POS PPO Provider Select Tier II Select Open Access
City of Crowley Employee Plan	PPO
Cook Children’s Health Plan	PPO
Coventry/First Health	PPO
Evry Health	PPO
Friday Health	PPO
Galaxy Healthcare	PPO
Global Health	PPO
Healthcare Highways	PPO
HealthSCOPE Benefits Inc Dart	PPO
HealthSmart	Accel GEPO PPO
Humana	ChoiceCare HMO PPO
Humana Military	TriCare East
Imagine Health	EPN
Imperial Health	Medicare Advantage
Independent Medical System	PPO
Medicaid	TMHP Medicaid
Medicare	HMO Medicare Advantage Plan PPO Traditional
Molina	CHIP Dual Medicare-Medicaid Plan Exchange Network Medicaid HMO Medicare Advantage STAR Medicaid HMO
MultiPlan	PPO
National Preferred Provider Network	PPO
Nexcaliber	PPO
Oscar Health	EPO HMO PPO Prime Medicare Advantage
Prime Health Services Group	PPO
Private Healthcare Systems	PPO
Provider Select	PPO
Superior Ambetter	Commerical Exchange Value Plans
Superior HealthPlan	CHIP Foster CHIP RSA Medicare-Medicaid STAR Medicaid HMO
Three Rivers	PPO
UnitedHealthcare	Medicare Advantage UHC Choice Plus
USA Managed Care Organization	PPO
Wellcare	Medicare Advantage HMO

What if I Don’t have Health Insurance?

If you do not have health insurance, there are several options:

Get health insurance through the Affordable Care Act. We have certified marketplace navigators to help you find the best plan for your care.
You may be eligible for grant and/or government-funded assistance programs.
You may qualify for sliding fee rates.
Ask about flexible payment plans.

Assistance Program Eligibility

If you are uninsured, our eligibility specialists can help you find grants and government-funded programs to help lower the cost of your health care. Eligibility requirements vary between programs, but many are based on residency and income.

Each health center has eligibility specialists there to help you navigate these programs’ application and documentation processes.

How to Make an Appointment with an Eligibility Specialist:

Ask our front desk representative about making an appointment.
Call our main line at 214-521-5191.

Sliding Fee Rates

If you are uninsured and do not qualify for an assistance program, you may be eligible to receive care at a lower cost based on your household income and size. See this link to determine who should be included as part of your household.

The cost of your care is determined by where your household income lands on the current Federal Poverty Level (FPL) percentage chart.

The cost of different services is included in the tables below. The fee includes your medical visits, immunizations, and laboratory costs.

For people living above 200% of the Federal Poverty Level, you will be responsible for both the medical visit, as well as laboratory costs. The medical visit can be paid at the time of your visit, and you will be billed directly by the laboratory for any lab tests you may need.

To apply, please fill out the PHNTX – Sliding Fee Application.

How to Find My Fee Rate

You will need the number of people in your household and your total household income. See this link to determine who should be included as part of your household.
Take a look at the Federal Poverty Levels chart below. Match your household number in the first column and find where your household income lands on that row.
The percentage at the top of that column is your FPL percentage range.

Example: Morgan has four people in their household with a household income of $51,000. Their FPL range is 133-174%.

Next, find your Federal Poverty Level range in the first column of the Sliding Fee Rates chart below. Your costs for the corresponding services are on that row.

Example: Since Morgan’s FPL range is 133-174%, their medical visit cost is $135, and their counseling visit cost is $80 per visit.

Federal Poverty Levels 2024

People in Family/Household	< 100%	101 – 132%	133 – 174%	175 – 200%	> 200%
1	$0 – $15,060	$15,061 – $19,879	$19,880 – $26,204	$26,205 – $30,120	$30,121 or more
2	$0 – $20,440	$20,441 – $26,981	$26,982 – $35,566	$35,567 – $40,880	$40,881 or more
3	$0 – $25,820	$25,821 – $34,082	$34,083 – $44,927	$44,928 – $51,640	$51,641 or more
4	$0 – $31,200	$31,201 – $41,184	$41,185 – $54,288	$54,289 – $62,400	$62,401 or more
5	$0 – $36,580	$36,581 – $48,286	$48,287 – $63,649	$63,650 – $73,160	$73,161 or more

Note: For families/households with more than five persons, add $5,380 for each additional person.

Sliding Fee Rates

Federal Poverty Level	Medical Visit	Mental Health Visit	Counseling Visit	Preventive Dental Visit¹	Other Dental Visit¹	Pharmacy Fee²
< 100%	$10*	$10*	$10*	$100	$125	$0
101 – 132%	$80	$80	$40	$120	$150	75% Discount
133 – 174%	$135	$135	$80	$140	$175	50% Discount
175 – 200%	$190	$190	$100	$160	$200	25% Discount
> 200%	No Discount^{3 4}	No Discount⁴	No Discount⁴	No Discount⁴	No Discount⁴	No Discount⁴

* Effective on March 5, 2024

¹ Preventive Dental Visits include basic cleanings, exams, & x-rays. Other Dental Visits include any dental services outside of Preventive Dental Visits.

² Eligible medications are only those included in the PHNTX-approved medication list. If a medication on this list is available through another patient assistance program, you must use that assistance program before using PHNTX support. Sliding fee discounts only include administrative and distributing fees. You are responsible for the cost of the medication.

³ Does not include the laboratory costs. Patients above 200% of the FPL are responsible for laboratory bills directly.

⁴ Prompt Pay Discount (40% of total charges) available with full payment on the date of the appointment or within five (5) days of the date of the appointment.

Note: The FPL is published annually by the US Department of Health and Human Services. The FPL is commonly used to determine eligibility for certain income-driven programs and benefits such as Medicaid and CHIP.

How to Calculate My Federal Poverty Level

For individuals living with HIV, the FPL percentage range on the sliding fee scale is between 0% – 500%. You will need to calculate your percentage of FPL to find your fee rates.

You will need the number of people in your household and your total household income. See this link to determine who should be included as part of your household.
Find your poverty level amount by looking at the Federal Poverty Levels chart below. Match your household number in the first column. Your poverty level amount is the number to the right.

Example: Taylor has five people in their household. Based on the chart below, their poverty level amount is $35,140.

Next, take your household income and divide it by your poverty level amount. Then multiply that answer by 100. The final answer is your percentage of FPL.

Formula: (Household Income ÷ Poverty Level Amount) x 100 = Percentage of FPL

Example: Taylor’s household income is $80,000, and their poverty level amount is $35,140.

($80,000 ÷ $35,140) x 100 = 227.66% FPL

Then, find your Percentage of FPL in the first column of the Sliding Fee Rates chart below. Your costs for the corresponding services are on that row.

Federal Poverty Levels 2024

People in Family/Household	Federal Poverty Level (100%)
1	$15,060
2	$20,440
3	$25,820
4	$31,200
5	$36,580
6	$41,960
7	$47,340
8	$52,720

Note: For families/households with more than eight persons, add $5,140 for each additional person.

Sliding Fee Rates

Federal Poverty Level	Health Services	Oral Health Care	Mental Health Services	Prescription Medications⁵
< 100%	$0	$0	$0	$0
101 – 200%	$5	$5	$5	$5
201 – 250%	$5	$5	$5	$5
251 – 300%	$10	$5	$10	$10
301 – 350%	$20	$5	$20	$20
351 – 400%	$20	$5	$20	$20
401 – 450%	$30	Not Eligible	$20	$20
451 – 500%	$30	Not Eligible	$20	$20
> 500%	Not Eligible	Not Eligible	Not Eligible	Full Price

Annual Cap on Charges

Federal Poverty Level	Annual Cap Amount
< 100%	$0
101 – 200%	5% of annual gross income
201 – 300%	7% of annual gross income
> 301%	10% of annual gross income

⁵ Medications must be on the approved Ryan White medication assistance list. The cost shown in the sliding fee scale is the maximum charge to the patient versus the total cost of the prescription (administrative fees plus actual drug acquisition cost).

Patients who are not eligible for the sliding fee discount will be charged the administrative fee plus the actual cost of the medication. Generic medications should be used when available. This does not cover erectile dysfunction, human growth hormone, prescriptions for cosmetic purposes, non-medically necessary medication, or over-the-counter medications. Only one month of medications can be filled at a time.

Billing, Claims, and Payments

For all billing/claims inquiries or to make a payment, please call PHNTX’s main line at 214-521-5191.

Your Cost

Payment, Health Insurance, & Financial Aid Information

Building Equitable Healthcare for All Texans

Accepted Health Insurance Plans

Medical Services

Dental Care

What if I Don’t have Health Insurance?

Assistance Program Eligibility

How to Make an Appointment with an Eligibility Specialist:

Sliding Fee Rates

For People Not Living with HIV or Do Not Know Their HIV Status

How to Find My Fee Rate

Federal Poverty Levels 2024

Sliding Fee Rates

For People Living with HIV (Ryan White)

How to Calculate My Federal Poverty Level

Federal Poverty Levels 2024

Sliding Fee Rates

Annual Cap on Charges

Billing, Claims, and Payments