Patient Aid

|Patient Aid
Patient Aid 2018-09-24T13:47:07+00:00

Quarter 1 Deadline has passed

We will begin accepting applications again on October 1

Please check back on October 1 for the new application.

Thank you for your patience!

Patient Aid

The Leukemia Texas Patient Aid program awards assistance up to $1,250 per year to help patients with expenses associated with their leukemia treatment not covered by insurance or other third party providers. Applications to the program are accepted on a quarterly basis, at the end of March, June, September, and December and grants are awarded at the end of each application cycle. Once a patient’s application has been accepted, we ask that they wait one year before reapplying to the program.

Leukemia Texas Patient Aid Application

Eligibility and Process

Thank you for applying for patient aid through Leukemia Texas. Leukemia Texas is an independent nonprofit corporation dedicated to fighting the life-threatening blood cancer of leukemia through the funding of leukemia research and patient aid in Texas. Through our Patient Aid program, Leukemia Texas provides financial assistance to leukemia patients needing help with their necessary treatment expenses. This program currently serves hundreds of children and adults each year.

Eligibility:

  • Patient must be diagnosed and currently undergoing treatment for any form of leukemia.
  • Patient must be a legal citizen or legal resident of the United States of America.
  • Patient must be a legal resident of and currently live in the state of Texas.
  • Patient’s treatment and diagnoses must be validated by two persons providing care or assistance to the patient through their current physician’s office or hospital.
    • Those that can provide signature (need two):
      • Physician (MD or DO)
      • Physician Assistant
      • Nurse Practitioner
      • Social Worker
      • Financial Advisor
      • Practice Manager
  • Patient must be alive at the time that the aid is issued. Financial assistance related to postmortem expenses or expenditures incurred after death will not be considered.
  • Applicants may receive aid once within a twelve-month period. Window is based on when aid is received not on when application is submitted.

Process:

  1. If patient meets the eligibility criteria outlined above, they may apply for patient aid.
  2. Application can be downloaded from our website or filled out online at www.leukemiatexas.org
  3. Application must be legible and complete. For best results, fill out the application online prior to printing out, or submit online.
    1. Application must contain two signatures from physician or hospital staff along with all diagnosis information requested.
    2. Application must be signed by patient or legal guardian in order to be considered complete.
  4. Once application is complete, submit via email, fax or mail prior to due date listed on the application:
    1. Email: [email protected]
    2. Fax: (214) 265-8577
    3. Mail: Leukemia Texas, c/o Patient Aid, 4925 N O’Connor Road, Suite 125, Irving, TX 75062
  5. Once received, application will be held until processing which occurs about one week after deadline.
  6. Once all applications are processed, we will notify all applicants of the status of their application in writing via US mail.
    1. If you have not heard from Leukemia Texas six weeks after deadline, please reach out to Leukemia Texas to check on the status of your application
    2. Leukemia Texas relies on the accuracy of the information provided on each application. If you have a change of address after you submit your application, please reach out to Leukemia Texas to provide us with the current information.
  7. Leukemia Texas reserves the right to request additional documentation to validate application information.
  8. Leukemia Texas reserves the right to request a new annual application for all enrollees to ensure system accuracy and applicant eligibility, as we update our application each quarter.
  9. If you have any questions, please feel free to contact Leukemia Texas at (214) 265-7393 or [email protected]

Priorities of Leukemia Texas when approving Patient Aid:

(Priorities are not a determination of approval or denial, but a tool for our committee to evaluate our applicants based on our mission and patient needs)

  • Leukemia Texas was founded to assist patients across Texas, specifically with a leukemia diagnosis of any type. Due to the wide scope of the population that is affected by leukemia, we as an organization, do our best to serve those in greatest need, while understanding that all leukemia patients are in need of some sort or another.
  • Leukemia Texas requests that all applicants provide as much information as possible on their application to give our Program Committee the best idea of how their leukemia diagnosis has affected them financially.
    • In the narrative, please provide a description of the current financial state the patient is in due to the diagnosis:
      • Provide information about what financial strains are put on the patient due to the current treatment plan they are or will be going through.
      • Provide information on any other obstacles that are now adding to the financial strain due to the leukemia diagnosis.
  • Leukemia Texas and the Program Committee will look at all information provided in the patient’s application to determine their priority when compared to all other applications submitted:
    • Leukemia Texas priority for patients:
      • Priority will be given to those patients that have expressed a financial need based on the treatment they will undergo requiring 100+ visits to the hospital for treatment
      • Priority will also be given to those that may require travel of longer distances to receive their therapy, incurring higher expenses due to the length of travel, cost of parking or even multiple overnight stays during treatment
      • Priority will be given to those patients in a situation of little or no insurance.
        • This priority is not stating that simply because one has insurance they will not receive priority over someone else. Insurance can be present, but still have very costly attributes, i.e. high deductibles and prescription copays. Through proper description of their financial situation in the narrative of the application, patients are able to best present their need, even while having insurance.
        • We also recognize that certain treatments are not covered by insurance, i.e experimental medications, clinical trials, etc.
  • Patients that are US citizens or legal US residents, residents of Texas and currently undergoing treatment for any form of leukemia are still able to apply, but realize that we look at each application carefully to consider who will receive funding first.

If you find yourself eligible per the requirements above, please continue on to the online application by clicking the Online Application button below, OR

To fill out a printable form, please click on the button for the Printable Patient Aid Application below.

Quarter 1 Deadline has passed

We will begin accepting applications again on October 1

Please check back on October 1 for the new application.

Thank you for your patience!

  • There will be no exceptions for late or incomplete applications.
  • Please read the directions carefully and complete ALL areas of the patient aid application, as incomplete applications will not be considered.
  • Submission of an application does not guarantee funding.
  • Written notification of the STATUS of your application will be sent within 6 weeks of the quarterly deadline.
Online Patient Aid Application
Printable Patient Aid Application