Online Portals: For Patients | For Medical Healthcare Providers.**Please note the call center is experiencing high call volume and wait times are longer than usual.** Your application will be reviewed, and you will be notified of your status. Submitting the application doesn't guarantee acceptance in the program. Please note: There is a separate portal for the Co-Pay Assistance Program.Īwards are based on a first-come first-served basis, for as long as funding is available. Online Portals: For Patients | For Medical Healthcare Providers.Therapist, Counselor, Psychologist, Psychiatrist.*Medical healthcare providers may include: A VALID NPI NUMBER WHETHER APPLYING ON THE PORTAL OR BY PHONE DIRECT ACCESS TO THE PATIENT’S MEDICAL RECORDS TO ATTEST TO THEIR DIAGNOSIS HEALTHCARE TEAM MEMBER MUST HAVE THE FOLLOWING TO APPLY: NOTE: this is a temporary workaround given the national health emergency.įor new applicants, in the event that you are unable to get your doctor to sign off on the Diagnosis Verification Form for your application, we will accept a portion of your electronic medical record (EMR) or other documentation that shows the diagnosis/ICD-10 code. This information will not be shared and is for verification purposes only.The name of treating physician and his/her phone/fax numbers.o If the patient is a minor, you will need a guardian Social Security number as well.The patient’s demographic information (including their Social Security number and date of birth) and their contact information.Patients must have a confirmed diagnosis of blood cancer, be in active treatment, scheduled to begin treatment or in follow up care, all attested to by the patient or care team member.Click here for a list of eligible zip codes. Patients must reside in designated zip codes declared for individual assistance by FEMA.citizens or permanent residents and reside in the U.S. This will help patients offset non-medical expenses including housing, utilities and food, etc. The LLS Financial Relief Fund provides a one-time $250 award to eligible blood cancer patients experiencing financial hardship due to the hurricanes. Program continuation is dependent on the availability of funds and the program could be modified or discontinued at any time if funding is limited or no longer available.** Covered Expenses **As a non-profit organization, we rely on the generosity of our sponsors. Patients who have already received assistance from the Patient Aid Program and other LLS Patient Financial Assistance Programs can apply. The fund is designed to alleviate financial hardship as a result of the hurricanes. We are amplifying our efforts to provide patients and their families with financial support and have established a Financial Relief Fund. The Leukemia & Lymphoma Society (LLS) is concerned with the wellbeing of blood cancer patients Impacted by Hurricanes Fiona & Ian. To access this page in Spanish, click here.įinancial Relief for Patients Impacted by Hurricanes Fiona & Ian
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