Join the Network

If you are in private practice, or are a charity clinic or a  FQHC, consider joining our network. Providers accept a subset of patients under CCN’s reduced payment system; the number of patients accepted is completely per the provider’s discretion. Even accepting a few patients into your busy practice, when multiplied over our network, provides access to care for numerous individuals lacking insurance. While the introduction of the Affordable Care Act has helped fill this gap, there are still many individuals who fall out of the system because they have no legal status or are visitors. In addition  many immigrants and citizens  are also unable to purchase health coverage because the premiums are too expensive. CCN patients pay a fee of $25 per visit for PCP visits and $35 per visit for specialist consultations  and dentist’s  initial evaluations. In addition they pay for labs and imaging services as well.

PROVIDER AGREEMENT

    YES I AM WILLING TO JOIN THE COMPASSIONATE CARE NETWORK AND HELP. I UNDERSTAND THAT THIS IS ONLY TO PROVIDE NON URGENT OFFICE SERVICES FOR THE UNINSURED. I AGREE TO CHARGE NO MORE THAN $25.00 FOR THE OFFICE VISIT (PRIMARY CARE CONSULTATION) OR $35.00 (SPECIALIST CONSULTATION). I WILL BE ABLE TO SEPARATELY BILL THE PATIENT FOR LABS AND IMAGING SERVICES IN ADDITION TO THIS. IF I DISPENSE MEDICATIONS IN MY OFFICE I WOULD BE ABLE TO CHARGE THE PATIENT, FOR THEM SEPARATELY AS WELL.
    ADD ME TO THE CCN PROVIDER LIST.
    CHECK THIS BOX IF YOU AGREE THAT ALL STATEMENTS ARE TRUE, AND THAT YOU ACKNOWLEDGE THAT YOU ARE THE PERSON FOR WHO, THIS FORM IS FILLED OUT.

    Select Payment Method

    Offline Payment Information

    Select Enroll Type

    New Enrollment for 6 months
    Renewal Enrollment for 12 months