Patient Portal

Medical Access Program

MAP Rules & Regulations

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  • Must pay co-pay at time of office visit or the appointment will have to be rescheduled (No exceptions will be made)
  • 22-visit limit (including one physical a year)
  • Doctors are not accepting new pain management patients
  • Must have a face-to-face visit with a provider or charges will be the patient’s responsibility (ex- labs will not be covered unless seen by a provider on same dos)
  • Basic labs are covered. If a lab is not covered the nurse or provider will have patient sign a waiver stating that the labs are the patient’s responsibility and must be paid at time of appointment. If you receive a bill from LabCorp please contact us immediately.
  • Medications are not covered
  • Vaccines are not covered for adults (Patient can pay out of pocket or go to Health Department for administration), with the exception of the FLU vaccine, which will be given within an office visit.
  • STD Checks are not covered (Patient can pay out of pocket or go to Health Department for this lab work)
  • Cosmetic procedures are not covered (ex-skin tag removal)
  • DOT, short physicals and TB skin tests are not covered
  • Any visit pertaining to an automobile accident or workers compensation injury will not be covered (Must be paid for out of pocket)
  • Any medical care received outside of Black River Health Services will not be covered by the MAP program (This includes specialists, hospital stays and procedures, etc.)
  • Any patient providing false information will be removed from the MAP program and all charges that have been written off will then become the patient’s responsibility.
  • If patient’s income changes or patient starts receiving insurance please notify the Billing/Insurance office immediately.
  • Coverage will expire on June 30 of each year. Must be renewed in person with updated information, if not charges will be the patients responsibility.

MAP Income Verification Requirements

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  • Income tax form (Most recent calendar year-must be signed and dated)
  • W2
  • Last 3 current check stubs
  • Social security benefit letter
  • Child support
  • Retirement
  • Alimony
  • Dividends

(Proof may be shown in the form of bank or dividend statements, court orders or government award letters.)

The entire household’s income must be shown. Any patient providing false information will be removed from the MAP program and all charges that have been written off will then become the patient’s responsibility.

If the household has no income we will need:

A notarized letter from the person or persons; who is currently supporting you. If you have lived with this person for more than 6 months we must show their income. We will need proof of your living status (mail from previous address dated to prove you have only been living at current address for less than the allotted time frame)

Patient must have a current picture ID (a copy must be attached to the application)

Note: If patient does not bring in all the required documents the appointment will be rescheduled. NO EXCEPTIONS!!