NOTE: If you are eligible to apply and would like to give access to another party (family member, social worker/patient advocate) to assist with completing the application and filing claims, please invite them to access your application by clicking the Invite Collaborators link on the application page. 

TYPE OF FINANCIAL ASSISTANCE OFFERED: The CLRA Patient Aid Program is a co-Pay assistance program for reimbursement of leukemia/blood cancer related medical bills that are listed under “Covered Treatments and Services”. Upon approval of each claim, payment will be made to the patient or guardian as applicable.

ELIGIBILITY: Programs are available for adults and children with leukemia or any type of blood cancer, 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 served basis. A new application is required each year for further assistance. Financial aid for programs is subject to the availability of funds.

ASSISTANCE AND PROGRAM DATES: The maximum assistance to each patient is $3,000.00 for approved claims within the dates of service between November 1, 2020 and October 31, 2021. The deadline to receive claims within our guidelines is December 1, 2021

TERMINATION: Enrollment in each program is automatically terminated if no claims have been submitted within a four-month period of initial enrollment date.


COVERED TREATMENTS AND SERVICES PRESCRIBED BY YOUR TREATING FACILITY:

Prescriptions:

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.

Treatments and services:

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.

NOT COVERED:

DO NOT SUBMIT BILLS FOR: Health insurance premiums, cobra payments, medical supplies/equipment (including masks)/accessories, physical therapy, osteopath therapy, massage, acupuncture, acupressure, home healthcare, caregiving, prescription delivery fees, dentistry, optometry, facility parking, basic living, lost wages, travel or lodging expenses. Ambulance, emergency room, and hospital stays (observation, private rooms, discharge fees, hospital fees).

COMPLETED applications are approved on a first-come, first-served basis. Please allow up to 30 days for processing.

A new application is required each year for further assistance.

*All information is confidential and HIPAA compliant*

We use Submittable to accept and review our submissions.