Patient Aid Program Summary

TYPE OF FINANCIAL ASSISTANCE OFFERED: Co-Pay Assistance Programs help with leukemia-related medical bills that are listed under “Covered Treatments and Services”. Upon approval of each claim, payment will be made to the patient, guardian or medical provider as applicable.

DO NOT SUBMIT BILLS FOR: Health insurance premiums, medical supplies/equipment/accessories, home healthcare, caregiving, facility parking, basic living, lost wages, travel or lodging expenses. These services are not covered in the financial assistance programs.

ELIGIBILITY: Programs are available for adults and children with any type of leukemia, residing and receiving treatment within the United States, having U.S. citizenship (SS#), or a Legal Residency or ITIN number. No proof of income is required. Medicaid recipients are not eligible for our programs.

ENROLLMENT: Programs open for enrollment every January 1st on a first-come/first-serve basis. A new application is required each year for further assistance. Financial aid for programs is subject to the availability of funds.

PATIENT AID PROGRAM: The maximum assistance to each patient is $1,500.00 for approved claims within the dates of service between November 1 and October 31 of following year. The deadline to receive claims within our guidelines is December 1st of each year.

MATCHING DOLLAR PROGRAM: The maximum Matching Dollar assistance to each patient is $1500.00 for approved claims within the dates of service. The deadline to receive claims is December 1st of each year. Funding for this program is derived from donations made to Children’s Leukemia Research Association. For more detailed information, please refer to the “Matching Dollar” program page.

TERMINATION: Enrollment in each program is automatically terminated if no claims have been submitted within a four-month period of initial enrollment date. Extensions to file claims are limited. To request a maximum of two additional month, please contact the office within the four-month filing period to remain enrolled. If you know in advance it is not possible to submit a claim within stated time frames, you may apply to have your name entered directly on a waiting list (this request is not available to those granted extensions or terminated from enrollment).

COVERED TREATMENTS AND SERVICES PRESCRIBED BY YOUR TREATING FACILITY:

Office visits, routine exams and blood tests, other diagnostic and lab tests including those on various organs and systems used to determine how your leukemia and its treatment are affecting them.

IV chemotherapy, IVIG therapy, radiation therapy, post-bone marrow transplant therapy.

PRESCRIPTIONS FOR:

Oral chemotherapy, IVIG, immunosuppressants, preventative antibiotics, neutropenia, thrombocytopenia, pain and numbing, anti-nausea, anti-anxiety, anti-depressants, blood thinners, vitamins/minerals

**Graft vs Host Disease: Liver/gallbladder/gastrointestinal/skin/anti-biotic-viral-fungal

**We also accept these from members who do not have GVHD.

TO APPLY: Click on the Patient Aid Application page under the Patient Aid tab, or request one by mail.

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