2016 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. A new application is required each year for further assistance. Financial aid for our programs is subject to the availability of funds.
PATIENT AID PROGRAM: The maximum assistance to each patient is $1,500 for approved claims for dates of service from November 1, 2015 to October 31, 2016. The deadline to receive claims within our guidelines is December 1, 2016.
MATCHING DOLLAR PROGRAM: The maximum assistance to each patient is $3,000 for approved claims for dates of service from November1 2015 thru October 31, 2016. The deadline to recive claims is December 1, 2016. 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.
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 time frames, 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 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 EFFECTING THEM.
IV CHEMOTHERAPY, IVIG THERAPY, RADIATION THERAPY, POST-BONE MARROW TRANSPLANT THERAPY
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.