Children's Leukemia Research Association, IncGive Now!
 
Patient Aid   > Summary
Matching Dollar Program
Patient Aid Application

Learn about our Matching Dollar Program HERE PATIENT AID SUMMARY

The mission of the Children’s Leukemia Research Association remains - to find the cause and cure for this insidious disease while rendering support to those in need.

CLRA helps lessen the financial burden of leukemia by providing co-pay assistance to eligible children and adults for certain medical expenses related to the treatment of the disease.

The demand for our programs is overwhelming, and each year – through the donations of dedicated individuals and corporations - we are able to help as many people as possible.

Our Patient Aid and Matching Dollar programs open for enrollment on January 1st on a first-come/first-serve basis until they become full, and are subject to the availability of funds throughout the year.

Eligibility for our programs consists of being diagnosed with leukemia, residing and receiving treatment within the United States, and having U.S. citizenship or legal residency.  Applicants must also meet the criteria described in the Program Guidelines below, and follow the instructions given under the How to Apply section.

Josh Marks and family


Thank you so much for your generous support during our long journey and fight against childhood leukemia.

Without your help this would indeed be more of a financial burden.

Sincerely,
The Marks Family!

 

CLRA’S PROGRAM GUIDELINES                                            

Both of our Co-Pay Assistance programs run from January 1st through December 31st each year which constitutes the enrollment period. 

Patient Aid Program: 

This program is designed for those who are continuing, starting or resuming leukemia treatment and/or lab tests this year. 

We offer to reimburse paid medical expenses up to $1,500 for our Covered Treatment and Services that are incurred within the year of enrollment.  If these expenses are unpaid, we pay your medical provider directly.  After the maximum in aid is met, members are welcome to apply for our Matching Dollar Program to assist with the remainder of their medical expenses for the year.

Once the program is full, we encourage those seeking co-pay assistance to apply for our Matching Dollar Program instead.

Termination:  Enrollment in the Patient Aid Program is automatically terminated if no claims are received by us within four months following your enrollment date.  You must alert us before this four month period ends as to the reason you have not submitted a claim in order to remain enrolled in the program.

Matching Dollar Program: (See our Matching Dollar page for details)

This program is designed for those who missed applying for our Patient Aid Program due to its being full, and who received leukemia treatment and/or lab tests for our Covered Treatment and Services during the current or prior calendar year.  This includes those in remission who have covered expenses from this period, and remains available to those in our Patient Aid Program who met the maximum in aid.

We invite the applicant, with help from their family, friends and associates, to make a donation on behalf of the patient.  We then match up to $1,500 of these funds made payable to our organization, and reimburse paid expenses up to $3,000 for our Covered Treatment and Services incurred within the abovementioned periods.  If these expenses are unpaid, we pay your medical provider directly.

 Covered Treatment and Services:

  • Oral Chemotherapy; IV Chemotherapy or Radiation Therapy (Outpatient only);
  • Anti-nausea prescription drugs while in treatment;
  • Leukemia-related laboratory tests;
  • Post Bone Marrow/Stem Cell Transplant therapy prescriptions for Tacrolimus and various anti-biotic, fungal or viral medications (transplants are not covered)

 Non-Covered Treatment and Services:

  • Medications which treat the side effects caused by the disease or its treatment, with the exception of anti-nausea prescriptions.  Antibiotics are only accepted for those in Post-bone marrow or Post-stem cell transplant therapy. 
  • Office visits and hospital stays; medical supplies/equipment;
  • Health insurance payments, home care, household, travel or lodging costs.

 How to Apply:

a.           Fill in, print and sign the Patient Aid Application available through our website:  childrensleukemia.org or sent to you by mail upon request.       Be sure to check off which program you are applying for. 

b.           Applications are accepted by mail only, and must be postmarked on or after the 1st of the year, or it will be returned to you.  Attach a copy of your insurance I.D. and make a copy of the application for your records.

c.           The physician treating you for leukemia must fill in and sign Section B on Page 2 of the application.  As an option, this is the only page we will accept by fax and we will add it to your mailed application.  Please write “To be Faxed” across this section, include it with your mailed application, and send your physician a separate copy of Page 2 to be faxed to us at 516-222-0457.  Note that we can only apply the first-come/first-serve basis to your application once all completed pages have been received.

d.           After mailing your application, allow two weeks for us to notify you by mail as to the status of your application.  Once your application is accepted, you will receive claim forms with instructions on how to submit your medical bills for reimbursement or payment to your medical provider. 

e.           Applications and claims are reviewed by our Patient Aid Director, under the guidance of our Medical Advisory Committee.  You will receive a confirmation that each claim has been received and whether it has been approved or if we require further information.  Please allow up to 30 days from your claim approval date to receive your check. 

f.             Prior members of our programs must apply with a new application each year if they are in need of co-pay assistance from us, with the following exceptions:

Those enrolled in our Matching Dollar Program whose additional donations (if any) were rolled over into the following year’s program; and

Those enrolled in our Patient Aid Program who are applying for our Matching Dollar Program need only submit Page 1 of the application.

All information received pertaining to applicants will be kept confidential.  Feel free to contact us with any questions concerning our programs at 516-222-1944.

Postal Address

CLRA
585 Stewart Avenue
Suite 18
Garden City, NY 11530

Tel:  516-222-1944
Fax: 516-222-0457

NYC Address

CLRA
244 Fifth Avenue
Suite #2969
New York, NY 10001

Tel: 212-491-1200

info@childrensleukemia.org


The CLRA is a not-for-profit 501(c)3
organization governed by a volunteer
Board of Trustees.

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Postal Address

CLRA
585 Stewart Avenue
Suite 18
Garden City, NY 11530

Tel:  516-222-1944
Fax: 516-222-0457

NYC Address

CLRA
244 Fifth Avenue
Suite #2969
New York, NY 10001

Tel: 212-491-1200

info@childrensleukemia.org


The CLRA is a not-for-profit 501(c)3
organization governed by a volunteer
Board of Trustees.