Financial Assistance Program
Affordable, Compassionate Mental Health Care for Everyone
At Elle Cliniques HTC, we are committed to providing high-quality, accessible, and compassionate mental health care for individuals across our service locations. We understand that financial concerns should never be a barrier to receiving the treatment and support you deserve.
We offer various payment options, insurance coverage, and financial assistance programs to ensure that all patients, regardless of their financial situation, can access the care they need.
Insurance & Payment Options
Elle Cliniques HTC proudly accepts a wide range of insurance providers, including:
✔ Aetna, Aetna Medicare
✔ Ambetter (Sunshine Health)
✔ Anthem
✔ Blue Cross Blue Shield (BCBS)
✔ Carelon
✔ Cigna, Cigna and Evernorth
✔ Humana
✔ Medicare & Medicaid
✔ Magellan
✔ Meritain Health
✔ Memorial Health
✔ Oxford
✔ Railroad Medicare
✔ Tricare
✔ Optum
✔ United Healthcare (UHC), United Medical Resources (UMR)
If your insurance provider is not listed, please contact us to discuss coverage and alternative payment options.
Insurance & Payment Options
For patients who are uninsured or prefer to pay out-of-pocket, we offer flexible self-pay options. Our team can work with you to create a customized payment plan that fits your financial situation.
Financial Assistance Program
At Elle Cliniques HTC, we believe that mental health care should be available to everyone, regardless of financial status. Our Financial Assistance Program is designed to help qualifying patients by offering discounted or reduced-cost services based on financial need.
Who Qualifies for Financial Assistance?
Patients may be eligible for financial assistance if they:
✔ Have limited or no insurance coverage for mental health services.
✔ Are experiencing financial hardship and meet income-based eligibility criteria.
✔ Require urgent psychiatric care but face financial obstacles.
How to Apply for Financial Assistance
Complete an Application – Our financial assistance application is simple and confidential. Contact our office for the form.
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Provide Supporting Documents – You may need to submit proof of income, employment status, or financial hardship.
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Review & Approval – Our team will review your application and notify you of eligibility within a few business days.
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Receive Discounted Care – Once approved, eligible patients will receive reduced-cost treatment options based on their financial situation.
For more details or to apply, please contact our office.
Why Choose Elle Cliniques HTC?
✔ Comprehensive Mental Health Services – Offering psychiatric evaluations, therapy, medication management, TMS, Spravato treatment, and more.
✔ Multiple Care Options – In-person, telehealth, and outpatient services available for flexibility.
✔ Dedicated Financial Support Team – We work closely with patients to find financial solutions that meet their needs.
✔ Patient-Centered Care – Compassionate, confidential, and personalized mental health treatment for every individual.
Household Size Annual Household Income
1 $0 – $ 30,120 $ 30,121 – $ 37,650 $ 37,651 – $ 45,180
2 $0 – $ 40,880 $ 40,881 – $ 51,100 $ 51,101 – $ 61,320
3 $0 – $ 51,640 $ 51,641 – $ 64,550 $ 64,551 – $ 77,460
4 $0 – $ 62,400 $ 62,401 – $ 78,000 $ 78,001 – $ 93,600
5 $0 – $ 73,160 $ 73,161 – $ 91,450 $ 91,451 – $ 109,740
6 $0 – $ 83,920 $ 83,921 – $ 104,900 $ 104,901 – $ 125,880
7 $0 – $ 94,680 $ 94,681 – $ 118,350 $ 118,351 – $ 142,020
8 $0 – $ 105,440 $ 105,441 – $ 131,800 $ 131,801 – $ 158,160
Discount on balance 100% 50% 25%
Families with more than 8 persons or in Alaska or Hawaii, contact Patient Financial Services
If you qualify for financial assistance, you will not be charged more than what individuals with insurance would typically pay for the same care. If there are any remaining balances that are not paid, Elle Cliniques HTC may need to take further steps to collect the amount due, which could include referring the balance to a collection agency. However, we are committed to working with you to find a solution and ensure you receive the care you need.
Limitations
Rogers’ financial assistance program helps with many costs related to behavioral health services, but it does not cover everything. Some expenses, such as transportation, lodging, prescriptions, food, medical equipment, lab services, and pharmacy supplies, are not included.
For routine outpatient services, applications can be submitted up to 12 months after your approval, but they will need to be resubmitted each year. If you are uninsured and eligible for Medicaid, you must apply for Medicaid unless you are exempt from social security and Medicare taxes, as documented on IRS Form 4029 or other official paperwork.
Method of Application
If you would like to apply for financial assistance or have been identified as potentially eligible, please contact "Patient Financial Services" at Info@ellecliniques.com to start the application process. In most cases, we will utilize our financial assistance screening tool to electronically evaluate eligibility.
If the eligibility tool does not report any findings or you disagree with the findings, you can complete a financial assistance application at no cost by contacting Patient Financial Services at Info@ellecliniques.com, visiting one of our locations, or by downloading and printing the application from our website.
To apply, you will need to complete and return the financial assistance application along with a few important documents, including:
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Proof of household income (such as pay stubs from the last 90 days)
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A copy of the last three months’ bank statements from all accounts in your household
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A copy of your last two tax returns (including all schedules) or an IRS Verification of Non-filing Letter
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Details of any personal injury or accident-related claims, if applicable
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Proof of any loss of income, if relevant
Once your application is submitted, a Patient Financial Services representative will review it. We will consider your application complete once we have received the form, all necessary documents, and any additional information we may request.