2015 CO-PAY ASSISTANCE PROGRAM SUMMARY
TYPE OF FINANCIAL ASSISTANCE OFFERED: Our Co-Pay Assistance Programs help with leukemia-related medical bills that are listed under our Covered Treatments and Services. Upon approval of each claim, payment will be made to the patient, guardian or medical provider.
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. We do not cover these services.
ELIGIBILITY: Our programs are open to 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: Our programs are open for enrollment every January 1st on a first-come/first-serve basis until they become full. Financial aid for our programs is subject to the availability of funds.
PATIENT AID PROGRAM: New dates apply* The maximum assistance to each patient is $1,500 for approved claims for dates of service from *November 1, 2014 to October 31, 2015. The deadline to receive claims within our guidelines is *January 15, 2016. Last year’s members can submit claims for dates of service between 11/1/14 and 12/31/14 until March 15, 2015.
MATCHING DOLLAR PROGRAM: New dates apply* The maximum assistance to each patient is $3,000 for approved claims for dates of service in *2014 only. Funding for this program is derived from donations made to us for up to $1,500 on behalf of the patient, which we will match with our own funds. Read our Matching Dollar Program page under the Patient Aid tab for important new provisions.
TERMINATION: Enrollment in each program is automatically terminated if no claims are received by us within 4 months after your enrollment date. Extensions to file claims are limited to 2 additional months, and must be requested within the above 4-month filing period in order to remain enrolled. If you know beforehand that you will be unable to submit a claim within these timeframes, you can apply now to be put directly on the waiting list (not available to those given extensions or terminated from enrollment).
COVERED TREATMENTS AND SERVICES: New items have been added**
Office visit co-pays and charges for Check-ups/Consultations, Oral and IV Chemotherapy
Radiation Therapy and Post-Bone Marrow Transplant Therapy
IVIG Immunoglobulin Therapy. Other preventative antibiotics are accepted for Post-BMT Therapy only.
Prescriptions for Anti-nausea, **Vitamins/Minerals, Heparin and Neutropenia
Lab test co-pays and charges that are leukemia-related and not due to infection. **We accept tests
on organs and systems showing how your leukemia and its treatment are effecting them, but the actual
treatment of certain side-effect conditions may not be covered.
*Post-Bone Marrow Therapy includes all of the above and additional prescriptions are limited to
Tacrolimus, antibiotic, antiviral and antifungal only.
TO APPLY: Click on the Patient Aid Application page under the Patient Aid tab, or request one by mail.