Self Pay Program
Swedish Family Medicine – Ballard Self Pay Program
Whether you are uninsured, underinsured or have insurance, we would be happy to be your health care provider!
For our underinsured or uninsured patients, we offer the Self Pay Program. (Please note that this program does not qualify as an insurance plan under the Affordable Health Care Act.)This is a program that allows access to primary care without the extensive cost. There is a monthly fee, paid at the first of each month, that covers a full range of services offered within the four walls of Swedish Family Medicine – Ballard. The full range of these services can be found in our Guide to Patient Services.
Monthly Fee by the numbers
|Number of family members*||Fee per month|
|Three or more||Additional $45 per family member|
*Family members include spouse, partner and children
Frequently Asked Questions About the Self Pay Program:
How do I sign up for the Self Pay (SP) Program?
You can print out, complete and sign the Enrollment Agreement form and bring it with you to your first visit, or you can fill it out at the clinic. Please bring your valid credit or debit card with your billing confirmation.
How is this credit or debit card information used?
In signing the Enrollment Agreement, you agree to have us bill your credit or debit card automatically on the first day of each month for the previous month's enrollment fee.
Is there any co-pay for clinic visits?
No. Your monthly fee covers all your visits, phone calls and e-mail contacts as well as all tests done in the clinic. (See Guide to Patient Services.)
Can I pay my monthly fees by cash or check?
No. One of the ways we are able to provide you with low cost health care is by eliminating complicated billing procedures. Automatic charges to your credit or debit card dramatically reduce costs for you.
If I did not use your services during the previous month, will I be billed for that month?
Yes. When you sign up for our medical services you agree to pay on a monthly basis, whether or not you need our services that month.
Is there a limit to how many visits I can have in a year?
No. You and any enrolled family members may see your doctor as often as you need to, based on schedule availability.
If I am enrolled in the SP Program, do I still need health insurance?
While health insurance is not a requirement, we recommend that you obtain some form of standard or catastrophic insurance in the event that you require emergency room care, hospitalization, specialty or long-term care. Insurance may help pay for some of these costs.
If I have health insurance, can I enroll in the SP Program?
If you are covered by Medicaid, Medicare or private insurance, it may not make sense to be in the program. However, if you have insurance with a high deductible (over $500/year) it could be beneficial as the SP Program costs approximately $660/year.
What about services that I might need outside of the clinic?
At times, your physician may refer you for tests or to see a specialist outside of our clinic. Though your monthly fee does not cover these services, we can provide you with a list of referral options, some of whom may offer discounted rates.
What should I do if I have an emergency?
If you suspect a life threatening emergency, call 911 immediately. If you have an urgent, non-life threatening condition - a minor cut, infection or acute illness - call our office to speak with a member of our health care team. If you do not need emergency care, we will see you in the clinic at the earliest opportunity.
Please note that the monthly Self Pay fee does not cover the costs of ambulance transportation, emergency room care, hospital services or follow-up specialty care.
If I get pregnant, will the SP Program cover my prenatal and hospital care?
No. We do not provide comprehensive pregnancy care including preconception counseling, prenatal, labor and delivery, postpartum and newborn care under the program. Please contact our front desk staff to discuss other options for your pregnancy coverage.
Can my child/children be a SP patient if I am not enrolled as a patient at the clinic?
Yes. Your children can be enrolled even if you are not enrolled. You would still need to provide a valid credit/debit card for the monthly fee.
Can I end the SP enrollment at any time?
Upon signing the agreement, you agree to a minimum of six months, if after those six months, you choose to stop using the program you can do so with the Self Pay Cancellation form. This form can be completed and faxed to 206-297-5151, mailed to our address or dropped off directly to the front desk. Once you end your membership, you may not be able to re-enroll for six months.
What if I have limited income?
You may qualify for Swedish financial help or state insurance. You can contact our Ballard Financial Counselors directly at 206-781-6065 for more information.
Swedish Family Medicine - Ballard1801 NW Market Street, Suite 403
Seattle, WA 98107
Monday-Friday, 8 a.m.-5 p.m.
Map & Directions
Find a Clinic by Neighborhood
- Download patient forms
- Insurance plans accepted
- Medicare Advantage
- Common health concerns
- Types of Providers
MyChart lets you manage your health care from a computer or smartphone, 24/7
Get first aid and parent advice on the go with Swedish Kids Symptom Checker app, now available for iPhone and Android. Download the free app here.
Print and fill out your forms prior to your first appointment here.