How to Become a Patient

To become a new patient and learn about the steps to register, please call our

Main Clinic front desk at 970-668-4040 and tell them you are a "new Care Clinic patient". 


Medical Records

Current Patients

If you would like us to send your medical records to a different provider, please complete the health information authorization form and give it to our front desk staff or fax it to 970-668-6699. Please allow 30 business days for processing. 

Not a patient

If you would like us to receive your records from a previous provider, please complete the health information authorization form and give it to our front desk staff or fax it to 970-668-6699. Your previous provider will respond to our request on their timeline.

Call: 970-668-4040



Review of Records

You have the right to review your health records with your provider. Complete this Request for Access form and give it to our front desk or fax it to 970-668-6699. Your provider will review your request and contact you. 

You have a right to review your medical records with a provider’s review. If you have concerns, please review the NOTICE OF PRIVACY PRACTICES. You can also review the United States Health Resources and Services Administration (HRSA) policy on the HRSA Privacy Rule

If you have questions about medical records, please call 970-668-4048.
 


Patient Forms


Payment options:

 

UNINSURED

Care Clinic fees are accrued based on the care you receive. The staff at the Summit Community Care Clinic will do our best to provide you with a cost estimate. You are required to pay the entire bill at the end of each visit. If needed, we are willing to offer you a payment plan.

In order to qualify for a Care Card (sliding fee scale) to receive discounted services, you need to fill out additional forms and go through a formal screening process. We recommend that you complete this process before you need services because of the additional time necessary to process your information.

1. Call 970-668-4040 and let the staff know you are a new SCCC patient.

2. Next, complete these forms:

a. Complete this Care Card Application (English) or Care Card Application (Spanish)

3. To be considered for the Care Card and receive discounted services, submit your completed application with your supporting documentation to our Clinic or your local School-Based Health Center Clinic via drop off, mail, or email. The Eligibility Coordinator will evaluate your application and, if eligible, place you on a Sliding Fee Scale and issue your Care Card. Your co-pay based on the Care Card is payable upon check-in for each appointment and any additional fees not covered on the Care Card are due at the end of each visit. If necessary, we will work with you on a payment plan for the settlement of outstanding visit charges. 

As a Certified Assistance Application Site, we can also assist you with your Medicaid application. Please submit your completed Medicaid application at the same time of your Care Card application to avoid duplicating supporting documentation.

Prefer to meet in person with our Eligibility Coordinator?  Call 970-668-4040 to schedule an appointment. Please arrive 15 minutes early and bring your completed application forms.

970-668-4040

If you are very ill and need an appointment but have not gone through this process or received your Care Card, let our front desk know. Every attempt will be made to work with you to make sure you get the care you need.

During the Care Card process, we will review your income and family size and, if you are eligible, place you on the Sliding Fee Scale. Fees are accrued based on the care you receive. We can only provide you estimates of costs.

You will need to pay your entire bill at the end of each visit, but we will work with you on a payment plan as needed.

SLIDING SCALE FEE CODES

 

SLIDING FEE SCALE

During the new patient eligibility process, you may be assigned a Fee Code on the Sliding Fee Scale based on your income and family size, according to a calculation based on current Federal Poverty Guidelines.

The discounted fees cover many services except for certain laboratory services from outside the Care Clinic.

If you receive services that are not covered, you will be informed of the cost of the service, and payment will be expected at the time of service.

Sliding scale fee codes

 

PRIVATE INSURANCE

We are in-network with many carriers. However, you should also check with your insurance to confirm that we are an in-network provider.

We submit your in-network claims to your insurance company for the care you receive. Co-pay is due at the time of service. 

In-network insurance:

  • AETNA PPO
  • Anthem/Blue Cross Blue Shield
  • Cigna
  • Cofinity
  • Humana
  • Lucent Health
  • Medicaid/CHP+
  • Medicare
  • Multiplan/PHCS
  • PNOA (Providers Network of America)
  • Rocky Mountain Health Plans (RMHP)
  • UHC PPO/UMR
  • Veterans/TriWest

 

If your insurance carrier is not in-network, we cannot directly bill your insurance. You will need to pay the out-of-network cost to receive service with us.

Co-pays are collected at the time of service. We will submit your claim to your insurance company. You will receive a billing statement for any remaining fees not covered by insurance.

Settlement of your bill is required within 30 days of the statement date. If you receive services that are not covered, you will be informed of the cost of the service, and payment will be expected at the time of service.

 

MEDICAID and CHP+

When you make an appointment, let us know that you have Medicaid, CHP+ or Medicare. Bring your cards with you to your appointment.

Any copays or fees required by Medicaid or CHP+ will be collected at the time of service. If you receive services that are not covered, you will be informed of the cost of the service, and payment will be expected at the time of service.

As a Certified Assistance Application Site, we can also assist you with your Medicaid application. This form answers Frequently Asked Questions about Medicaid.

 

 

MEDICARE

When you make an appointment, let us know that you have Medicare. Bring your card with you to your appointment.

Any copays or fees required by Medicare will be collected at the time of service. Your signed acknowledgment of an Advanced Benficiary Notice (ABN) is required, confirming that you will pay for all services not covered by Medicare. If you receive a non-covered service, you will be informed that these services are not covered, and will be patient responsibility.

 

DENTAL INSURANCE

We are in-network with many dental insurance plans and you will be charged for services according to your individual plan. If you do not have dental insurance and have a current Care Card, you will be charged according to the Sliding Fee Scale. If you have an out of network insurance plan, we will courtesy bill your insurance. We can also offer you a recurring payment plan.

We accept the following dental insurance:

  • Aetna
  • Anthem
  • Cigna
  • Dentaquest
  • Dentemax
  • Guardian
  • Humana
  • Medicaid
  • UHC
 

SENIOR DENTAL PROGRAM

We are a provider of the Colorado Dental Health Program for Low Income Seniors. This program provides access to dental care to individuals age 60 and over who are not eligible for dental services under any other dental health care program, such as Health First Colorado (Colorado’s Medicaid Program). Our eligibility staff will screen you for eligibility for this program.  As funds for this program are limited, eligibility does not guarantee coverage.


Price Transparency

Summit Community Care Clinic is committed to providing transparent pricing so patients can make informed decisions. Please use the estimated pricing as a guide but understand that costs may vary. Regardless, if you are uninsured or under-insured, you will not be denied care unless you have pending delinquent bills for previous services.

We cannot guarantee the accuracy of the pricing provided on the website. A final bill for services may be different. Summit Community Care Clinic is not liable for cost in service differences.

Payments listed are estimated gross charges – the full price before any insurance or sliding fee scales are applied. Whereas prices are the same for all patients, final charges will vary depending on negotiated health insurance provider costs, individual insurance plans, and patient’s benefit plan.

Cost of common procedures

No patient will be denied service due to inability to pay.

We respectfully acknowledge that Summit Community Care Clinic is situated on the original homelands of the Ute people. We recognize that in silence we continue to be complicit in the ongoing oppression of Indigenous People. Summit Community Care Clinic strives to create a culture of Diversity, Equity, and Inclusion. This land acknowledgement is a step in fulfilling our responsibility to critically look at the history of this land and our commitment to rectifying its present-day implications. We honor the keepers of this land and the land itself.

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Need help getting to an appointment? Our staff can assist those with disabilities in arranging transportation.

 “This health center is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Public Health Service employee under 42 U.S.C. 233(g)-(n).”

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