Patient Aid - Financial Aid for Leukemia Patients

Patient Aid
LeukemiaTexas

6060 North Central Expressway, Suite 416
Dallas, TX 75206
214.265.7393 voice | 214.265.8577 fax

For Texas leukemia patients who are under the care of a physician for the treatment of leukemia and need financial help for the cost of their treatment, the LeukemiaTexas Patient Aid program provides up to $1000 per year of financial assistance for necessary treatment expenses not covered by insurance or other third parties. Admission to the program is made on a case-by-case basis. Admission is granted for a period of one year at which time patients must reapply to the program. Eligibility for this program is subject to certain conditions. Please refer to the Patient Aid Application for all program terms and conditions. Patients who are interested in participating in the program are encouraged to submit an original, completed Patient Aid Application which may be downloaded from this site. All applications must be signed by both the patient (or patient’s parent or legal guardian as applicable) and the patient’s attending physician. This program is available to patients under the care of a licensed physician for the treatment of leukemia and who are United States citizens and legal residents of the state of Texas.

Program Guidelines

Guide for Approval
Subject to the approval by LeukemiaTexas of the Patient Aid Application, aid may be made available to patients who are under the current care of a licensed physician for the treatment of leukemia and who are in need of financial assistance for their necessary prescribed leukemia treatment expenses. Such patients must be United States citizens who are legal residents of the state of Texas.

Patient’s receiving aid from LeukemiaTexas may receive financial assistance from other agencies, but not for the same services or invoices. Patients receiving Federal, State, County or Local aid or Social Security, Medicare or Medicaid may be eligible for aid.

A LeukemiaTexas Patient Aid Application may be downloaded from this site. Please complete this application, and return the original signed by both the patient and the patient’s physician to LeukemiaTexas as indicated on the application form. Incomplete, unsigned or facsimile application will not be accepted. For questions about your patient aid application, please contact LeukemiaTexas at 214-265-7393 or email us at info@LeukemiaTexas.org.

By accepting LeukemiaTexas aid, all patients agree that acceptance of financial aid is subject to the availability of funds and patients compliance with the terms and conditions of the LeukemiaTexas Patient Aid program. Patient further acknowledges and agrees that LeukemiaTexas reserves the sole discretionary right to change or amend the terms and conditions of the Patient Aid program or terminate patient’s participation in the program.

LeukemiaTexas does not discriminate based upon age, race, gender or creed.

Scope of Assistance
The scope of financial assistance in the Patient Aid Program refers to leukemia and allied diseases.

The LeukemiaTexas Patient Aid Program provides funding for the treatment of leukemia as prescribed by a licensed physician and that is not paid for by insurance or any other third party.

LeukemiaTexas Patient Aid resources are limited. We cannot assist in the payment of transportation, lodging/housing, meals or other charges not directly related to the prescribed treatment of leukemia.

© 2009 LeukemiaTexas