LHF Patient Assistance Program Guidelines

 

Purpose

The Louisiana Hemophilia Foundation (LHF) Financial Assistance Program is part of LHF’s continuing effort to improve the quality of life of individuals and families affected by bleeding disorders. This program provides funds to eligible individuals and families who need assistance with expenses incurred in the care, treatment, or prevention of a bleeding disorder.

 

Eligibility

To be eligible for the LHF Patient Assistance Program, requests must meet the following criteria:

1. Applicants must be a patient who has a diagnosed bleeding disorder OR the parent/guardian of a minor child who lives in your home and who has a diagnosed bleeding disorder.

2. Applicants must reside in the state of Louisiana OR receive treatment for your/your child’s bleeding disorder in Louisiana.

3. Applicants must sign and submit the application for assistance.  Third party applications will not be accepted.

4. Applicants must complete all sections of the application thoroughly and accurately. If a question does not apply, it should be marked Not Applicable (N/A).

5. Applicants must provide supporting documentation to accompany the application.  Failure to provide appropriate documentation will impact future requests for assistance.

 

Administration

Assistance will be granted, and funds dispersed under the following conditions:

1. Applications are approved based on (a) available funding, (b) urgency of need, (c) previous assistance, (d) financial means, and (e) mission alignment.  Funding is not guaranteed. Applicants should allow at least two weeks for LHF to process their request.

2. Areas of assistance are limited to requests that connect with our organizational mission and include medical needs, access to care, and other needs associated with managing the patient’s bleeding disorder.

3. Assistance will go to patients whose income is at or below 400% of the federal poverty guideline.  Patients whose incomes exceed this may receive assistance in extenuating circumstances and with the approval of the majority of the Patient Assistance Committee.

4. When possible, assistance will be paid directly to vendors.

5. Requests over $500 must be reviewed by the Patient Assistance Committee and approved by the majority.

6. Assistance is limited to a maximum of $1,000 in a calendar year.

7. Applicants who are denied assistance will be notified with an explanation of why the application was not approved.

 

Confidentiality

LHF follows HIPPA guidelines regarding patient information and confidentiality:

1. Applications and information pertaining to funding requests are considered confidential.

2. Information from LHF’s Financial Assistance Program applications may be compiled for statistical purposes, and for compliance with local, state, federal or affiliate organization requirements. However, any publication of this data will be in aggregate form only and will not include names or any other information that could be used to identify individual applicants or recipients.

3. No personal information will be used or disclosed for any purpose other than that for which it was collected. At no time will personal information be shared with any individual, company or organization outside of LHF.