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Volume 9, Issues 4 & 5 Download for iPad

The most recent Gallup-Healthways Well-Being Index shows that the Affordable Care Act (ACA) is making progress in reducing the percentage of uninsured Americans, with an uninsured rate at its lowest point in seven years. Several surveys conducted in mid-2014 reported an estimated 12 million fewer uninsured people. This number would have been even lower if every state had expanded Medicaid.

It remains to be seen if this pace of reduction in the percentage of uninsured can be sustained in 2015 as the open enrollment period is much shorter than the initial 2014 Open Enrollment period, and it may be difficult to reach or convince those who chose not to sign up during the last open enrollment period to do so this year.

What is certain, is the continued need for support for those patients and families faced with high medical costs whether they are uninsured or underinsured.

In this issue, we outline some of the patient assistance services and resources that may be available to your patients.

The Affordable Care Act in 2015

The ACA sets a yearly limit on the amount a participant would have to spend on cost-sharing under non-grandfathered health plans for covered, in-network essential health benefits. For plan year 2015, the ACA Out-of-Pocket maximum is $6,600 for an individual and $13,200 for a family. This limit includes deductibles, coinsurance, copayments or similar charges for qualified medical expenses for the essential health benefits. It does not have to include premiums, balance billing amounts for non-network providers, out-of-network cost-sharing or spending for services considered non-essential health benefits.

According to a recent ASPE report (illustrated in Figure 1), in the first month of the 2015 Open Enrollment period 89 percent of the enrollees in federally facilitated marketplaces chose either the Bronze or Silver level plan. These plans generally have lower monthly premiums and higher patient cost sharing. As shown in Figure 2, plan participants will be responsible for 30% of the cost of covered benefits in a typical Bronze plan and 20% in a typical Silver plan.

The early trend shows more enrollees in the federally facilitated marketplaces are choosing plans with lower premiums for the 2015 coverage year.



Figure 1: ASPE Office of Health Policy December 2014



Figure 2: Typical Premium and Out-of-Pocket Costs Per Metal Tier

FEDERAL POVERTY GUIDELINES

The poverty guidelines are issued by the Department of Health and Human Services (HHS) each year and are generally published in the Federal Register in late January. The HHS poverty guidelines, or percentage multiples of them, are used as an eligibility criterion by a number of federal and state programs.

The 2014 numbers shown below are used to calculate eligibility for savings on private insurance plans in 2015. The 2015 Poverty Guidelines were updated January 20, 2015 and can be found on the HHS website at: http://aspe.hhs.gov/poverty/.

Guidelines for the
48 Contiguous States and the District of Columbia

Persons in family

2014 Poverty guidelines

2015 Poverty guidelines

1

$11,670

$11,770

2

15,730

15,930

3

19,790

20,090

4

23,850

24,250

5

27,910

28,410

6

31,970

32,570

7

36,030

36,730

8

40,090

40,890

In 2015, for families with more than 8 persons, add $4,160 for each additional person.

Poverty Guidelines for
Alaska

Persons in family

2014 Poverty guidelines

2015 Poverty guidelines

1

$14,580

$14,720

2

19,660

19,920

3

24,740

25,120

4

29,820

30,320

5

34,900

35,520

6

39,980

40,720

7

45,060

45,920

8

50,140

51,120

In 2015, for families with more than 8 persons, add $5,200 for each additional person.

 

Poverty Guidelines for
Hawaii

Persons in family

2014 Poverty guidelines

2015 Poverty guidelines

1

$13,420

$13,350

2

18,090

18,330

3

22,760

23,110

4

27,430

27,890

5

32,100

32,670

6

36,770

37,450

7

41,440

42,230

8

46,110

47,010

In 2015, for families with more than 8 persons, add $4,780 for each additional person.

SOURCE: http://aspe.hhs.gov/poverty

Medicare Prescription Drug Plan

Medicare offers prescription drug coverage under the Medicare Part D program. Medicare beneficiaries may obtain prescription drug coverage through Medicare Prescription Drug Plans (PDPs) or through a Medicare Advantage Plan (MA-PDs). While the monthly premium varies by plan, in 2015 the average national premium is $33.13.

Medicare beneficiaries are advised to join a Medicare drug plan when they are first eligible in order to avoid a late enrollment penalty. The enrollment period for Medicare Part D runs October 15-December 7 each year. Special enrollment periods for Medicare Part D are outlined in the CMS 2015 Handbook, Medicare & You.

Most Medicare Part D plans have a coverage gap (commonly called the “donut hole”) during which there is a limit on what the Part D plan covers for drugs. Initially, Medicare beneficiaries were responsible for 100% of the drug cost while in the coverage gap. The Patient Protection and Affordability Act of 2010 included a provision to begin closing this coverage gap and when fully implemented in 2020, Medicare beneficiaries will have a 25% coinsurance during the coverage gap.

Yearly deductibles vary between Medicare Part D plans, however in 2015, no Medicare drug plan may have a deductible of more than $320 before the drug plan begins to pay. After the deductible is met, the Medicare beneficiary and Part D plan each pay their share until the combined amount (plus the deductible) reaches $2,960. At this point, the Medicare beneficiary is in the coverage gap and responsible for 45% of the plan’s cost for covered brand-name drugs and a maximum of 65% of the plan’s cost for covered generic drugs.

Once the beneficiary’s True Out-of-Pocket (TrOOP) costs reach $4,700 the coverage gap ends and Catastrophic Coverage begins. While in the Catastrophic Coverage stage, costs for covered drugs are reduced to $2.65 for generics or $6.60 for brand-name drugs (or 5% of the drug cost - whichever is greater).

TrOOP includes the amount of the Medicare beneficiary’s initial deductible, co-payments or co-insurance during the initial coverage stage, the co-payments or co-insurance paid while in the donut hole and the 50% discount paid by the manufacturer on brand-name drugs while the beneficiary is in the donut hole.

For more information on the Medicare Part D drug coverage go to: www.medicare.gov/part-d

 

FEDERAL LAWS PROTECTING MEDICAL INSURANCE COVERAGE

The Affordable Care Act, which was signed into law on March 23, 2010, provides many benefits for individuals with chronic and/or costly health conditions such as cancer. Some of the key features include the elimination of yearly and lifetime limits on most covered health benefits and the insurers are prohibited from charging more or denying coverage because of a pre-existing health condition. The only exception is for certain grandfathered individual insurance plans.

However, individuals can buy a Marketplace plan that does not have a yearly limit on coverage and covers pre-existing conditions once their grandfathered plan year ends. For information on enrollment in a Marketplace plan visit www.HealthCare.gov.

In addition, new insurance plans are required to pay regular costs of care for in-network cancer treatment even if the patient is in a phase I, II, III, or IV clinical trial as long as the study meets one of the following requirements:

  • It is federally funded (any US federal agency such as the National Cancer Institute, Centers for Disease Control, Department of Defense, etc.),
  • It is covered under an investigational new drug application (IND) that’s reviewed by the FDA, or
  • It is exempt from the IND application process.

Nonetheless, the federal government has not issued regulations to guide implementation of this ACA requirement instead stating that the law is “self-implementing” and that “group health plans and health insurance issuers are expected to implement the requirements of PHS Act section 2709 using a good faith, reasonable interpretation of the law.”

In light of this, both the American Cancer Society (ACS) and the American Society of Clinical Oncology (ASCO) have extensive resources on insurance coverage of clinical trials under the ACA and current state laws.

The American Cancer Society provides information on federal laws that may protect medical insurance coverage when a person changes or loses a job, or loses benefits as a result of a reduction in the hours worked:

The Family and Medical Leave Act of 1993 (FMLA) requires employers (with at least 50 employees) to provide up to 12 weeks of unpaid, job-protected leave to eligible employees for certain family and medical reasons. Employees are eligible if they have worked for a covered employer for at least 1250 hours in the previous 12 months.

For the time period of the FMLA leave, the employer must maintain the employee's medical insurance. This act is regulated by the U.S. Department of Labor's Wage and Hour Division.

The Americans with Disabilities Act of 1990 (ADA) offers protection against discrimination in the workplace to anyone who has, or has had, certain disabilities, including any diagnosis of cancer. Parents of dependent children with cancer are also protected under this law. It requires private employers who employ 15 or more people, labor unions, employment agencies, and government agencies to treat employees equally, including the benefits offered them, without regard to their disabling condition or medical history.

It also does not allow employers to screen out potential employees who have children with disabilities. This law is administered by the U.S. Equal Employment Opportunity Commission (EEOC).

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) This bill has several clauses that can benefit cancer patients whose coverage is provided under a “grandfathered” plan in existence prior to the passage of the ACA. Although insurers cannot sell grandfathered plans to new customers, there is still a significant number of enrollees under these plans that have not moved to ACA plans. For this reason, the protections provided under HIPAA are still vital. These protections include the following:

  • A group health plan may not impose a pre-existing condition exclusion if the individual has had creditable medical coverage for at least 12 months and has not gone more than 63 days with no coverage.
  • If a cancer patient was previously uninsured and takes a job with an employer offering group insurance, the waiting period for preexisting conditions cannot be longer than 12 months (unless the individual enrolls late).
  • Insurers are required to renew coverage for all employers and individuals when premiums are paid.

The Secretary of Labor enforces the health care portability requirements on group health plans under ERISA, including self-insured arrangements. In addition, participants and beneficiaries can file suit to enforce their rights under ERISA, as amended by HIPAA.

Individual state laws may also provide additional protections. Information on state laws and contact information for your state insurance commissioner's office is available on the Website of the National Association of Insurance Commissioners at naic.org.

COBRA (Consolidated Omnibus Budget and Reconciliation Act of 1986) COBRA gives qualified employees and their families the right to temporarily continue health insurance coverage at group rates when coverage is lost due to certain specific events or qualifying events. COBRA is administered by the U.S. Department of Labor, COBRA information & FAQs are available on their Web site.

A better option for some people, especially those with lower incomes, would be to buy health insurance coverage from the Marketplace. In most cases, the qualifying event for COBRA coverage would also be considered a qualifying event for the special enrollment period in the Health Insurance Marketplace. When coverage is purchased through the Marketplace individuals may qualify for lower costs and/or lower out of pocket costs on their monthly premiums on private insurance. In fact, according to a recent Gallup poll, 85% of those who bought insurance through the Health Insurance Marketplace qualified for some degree of financial help.

Women’s Health and Cancer Rights Act of 1998
Under the Women’s Health and Cancer Rights Act (WHCRA) of 1998 health insurance plans must cover breast reconstruction in connection with a mastectomy if the patient decides to have reconstruction and received insurance benefits from her plan for the mastectomy. WHCRA does not require health plans or issuers to pay for mastectomies. However, if a group health plan or health insurance issuer does cover mastectomies the plan or issuer is generally subject to WHCRA requirements.

WHCRA does not apply to Medicare and Medicaid, as they are public health plans not issuers of health insurance.
The WHCRA is administered by the U.S. Department of Labor and the U.S. Department of Health and Human Services. Both of these agencies have Web pages with information about WHRCA including a list of frequently asked questions.

Helpful Resources
  The Air Care Alliance
Website www.aircarealliance.org
Phone 888-260-9707
Email mail@aircarealliance.org
The Air Care Alliance website provides a comprehensive list of free air transportation services for qualified patients and their families to specialized medical treatment facilities.
  Air Charity Network
Website http://aircharitynetwork.org/
Phone 877-621-7177
Air Charity Network is comprised of 7 independent member organizations identified by specific geographical service areas. Airlift Hope NC-TN, Angel Flight Central, Angel Flight Mid-Atlantic, Angel Flight Northeast, Angel Flight™ Southeast, Angel Flight West and Mercy Flight™ Southeast coordinate volunteer pilot missions in the continental United States as well as Alaska and Hawaii.
  American Cancer Society
Website www.cancer.org
Phone 800-227-2345
The American Cancer Society operates offices throughout the nation. The ACS can help patients locate various types of support and financial assistance.
  Andre Sobel River of Life Foundation
Website www.andreriveroflife.org/
Phone 310-276-7111
Email Info@AndreRiverOfLife.org
The Andre Sobel River of Life Foundation (ASRL) is a tax-exempt non-profit organization that provides financial assistance to single parents so that they can remain by their child's side throughout a life-threatening illness. ASRL meets urgent financial needs of single parent families of children with catastrophic or life threatening illnesses who are in financial crisis.
  The Assistance Fund
Website www.theassistancefund.org
The Assistance Fund provides access to medications through financial support for patients who are critically or chronically ill. The Assistance Fund may be able to help with copays, deductibles and health insurance premiums.
  Association of Community Cancer Centers
Website www.accc-cancer.org
ACCC maintains a comprehensive list of reimbursement assistance programs for oncology-related drugs and services.
  Benefits.Gov
Website www.benefits.gov
Phone 1-800-333-4636
Email Direct from website
Benefits.gov is a partnership of 17 Federal agencies providing improved, personalized access to government assistance programs. The online screening tool is free, easy-to-use, and confidential. The user answers a series of questions, then the website generates a list of government benefit programs that the user may be eligible to receive, along with information about how the user can apply.
  BenefitsCheckUp®
Website www.benefitscheckup.org
Email Direct from website
BenefitsCheckUp is a free service of the National Council on Aging (NCOA), a nonprofit service and advocacy organization. Through the online tool, the user completes an online survey to determine what state, federal or private benefit programs they may qualify for. Assistance is available for prescription drugs, health care, utilities, and other basic needs.
  The Bone Marrow Foundation
Website www.bonemarrow.org
Phone 800-365-1336
Email thebmf@bonemarrow.org
The Bone Marrow Foundation offers financial assistance and support services to bone marrow/stem cell transplant patients and their families.
  Cancer and Careers
Website http://www.cancerandcareers.org/
Phone  
Email cancerandcareers@cew.org
Cancer and Careers provides essential tools and information for employees with cancer including general information on insurance issues, legal rights in the workplace and filing for disability due to cancer.
  CancerCare® Co-Payment Assistance Foundation
Website www.cancercarecopay.org
Phone 866-552-6729
Email information@cancercarecopay.org
CancerCare® Co-Payment Assistance Foundation (CCAF) is a nonprofit organization that provides financial support for copays for certain drugs and diagnoses.
  Cancer Resource Foundation, Inc.
Website http://cancer1source.org/
Phone 508 -630- 2242
Email http://cancer1source.org
The Cancer Resource Foundation, Inc. has a national cancer genetic testing copay assistance program offering up to $520 toward the applicants "out of pocket" costs for genetic testing.
  Cancer Financial Assistance Coalition
Website www.cancerfac.org
The Cancer Financial Assistance Coalition (CFAC) is a coalition of 14 financial assistance organizations joining forces to help cancer patients experience better health and well-being by limiting financial challenges. Links are provided to each of the 14 member organizations.
  Cancer Legal Resources Center
Website www.disabilityrightslegalcenter.org/cancer-legal-resource-center
Phone 866-843-2572
Email clrc@lls.edu
The Cancer Legal Resource Center (CLRC) provides free and confidential information and resources on cancer-related legal issues to people with cancer, their families, friends, employers, health care professionals, and others coping with cancer. Callers can receive information about relevant laws and resources for their particular situation.
  CancerCare
Website www.cancercare.org
Phone 800-813-4673
Email info@cancercare.org
CancerCare is a national non-profit organization. They provide free professional support services for people affected by cancer. They also provide financial assistance for certain expenses related to cancer treatment.
  CancerCare Copayment Assistance Foundation
Website www.cancercarecopay.org
Phone 866-552-6729
Email information@cancercarecopay.org
CancerCare Copayment Assistance Foundation is a national non-profit organization affiliated with CancerCare. The foundation provides co-payment assistance for certain oral and IV cancer drugs. The foundation website maintains a list of covered diagnoses and medications.
  Catholic Charities USA
Website www.catholiccharitiesusa.org
Phone 703-549-1390
Catholic Charities offers financial assistance for practical needs including rent, utilities, food or transportation.
  Center for Medicare Advocacy, Inc.
Website www.medicareadvocacy.org
Phone 860-456-7790
The Center for Medicare Advocacy is a national non-profit advocacy group that provides education, advocacy, and legal assistance to help elders and people with disabilities obtain Medicare and necessary health care. The Center focuses on Medicare patients with chronic conditions, and those in need of long-term care.
  Centers for Disease Control & Prevention
Website http://www.cdc.gov/cancer/nbccedp/
Phone 800-232-4636
Email cdcinfo@cdc.gov
The CDC provides low-income, uninsured, and underserved women access to screening and diagnostic services, to detect breast and cervical cancer, through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The Breast and Cervical Cancer Prevention and Treatment Act of 2000 gives states the option to provide medical assistance through Medicaid to eligible women who were screened through the CDCs National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
  Colorectal CareLine
Website www.colorectalcareline.org
Phone 866-657-8634
Email CCL@patientadvocate.org
The Colorectal CareLine helps identify and facilitate financial assistance to colorectal cancer patients. As part of the Patient Advocate Foundation (PAF) the organization also supplies various patient resources and direct appeal assistance.
  Colon Cancer Alliance
Website www.ccalliance.org
Phone 877-422-2030
Colon Cancer Alliance's Blue Note Fund provides one-time grants of $300 to colon cancer patients who are currently in treatment.
  Co-Pay Relief
Website www.copays.org
Phone 866-512-3861
Email pap@patientadvocate.org
Part of PAF, The Co-Pay Relief (CPR) program provides direct financial support for pharmaceutical co-payments to insured patients, including Medicare Part D beneficiaries, who financially and medically qualify. CPR can provide co-pay assistance for patients with certain diagnoses. Physicians and patients can initiate a request for assistance.
  Corporate Angel Network
Website www.corpangelnetwork.org
Phone 866-328-1313
Email info@corpangelnetwork.org
Corporate Angel Network provides free flights transporting qualified cancer patients and their families to treatment facilities. Eligibility is open to all cancer patients, bone marrow donors, and bone marrow recipients who are not in need of medical support while traveling.
  Good Days from CDF
Website www.gooddaysfromcdf.org
Phone 877-968-7233
Email info@cdfund.org
Good Days from CDF (formerly known as Chronic Disease Fund) works through progressive assistance programs to provide financial support for patients who cannot afford the medications they need.
  Healthwell Foundation
Website www.healthwellfoundation.org
Phone 800-675-8416
Email info@healthwellfoundation.org
Healthwell Foundation is a non-profit, charitable organization that helps individuals afford prescription medications they are taking for specific illnesses. The Foundation provides financial assistance to eligible patients to cover certain out-of-pocket health care costs, including prescription drug co-insurance, co-payments & deductibles, and health insurance premiums. Lists of disease states & medications covered are available on their website. An on-line application is also available.
  Hope Lodge
Website www.cancer.org/treatment/supportprogramsservices/hopelodge/index
Phone 1-800-227-2345
Hope Lodge and the American Cancer Society offer cancer patients and their families a free, temporary place to stay when their best hope for effective treatment may be in another city. Currently, there are 31 Hope Lodge locations throughout the United States. Accommodations and eligibility requirements may vary by location. Find local lodging resources at www.cancer.org's Find Local Resources page by selecting the category Housing.
  HRSA Bureau of Primary Health Care
Website http://findahealthcenter.hrsa.gov/
The Health Resources and Services Administration (HRSA) helps patients find federally-funded health centers to care for them, even if they have no health insurance. Patients pay what they can afford, based on income. An on-line health services locator is available on the HRSA website to identify local health centers.
  IRS
Website http://www.irs.gov/
Phone 1-800-829-1040
The Internal Revenue Service (IRS) can provide information about tax deductions for medical costs that are not covered by insurance policies. For example, tax-deductible expenses might include mileage for trips to and from medical appointments, out-of-pocket costs for treatment, prescription drugs or equipment, and the cost of meals during lengthy medical visits.
  Joe's House
Website www.joeshouse.org
Phone 877-563-7468
Email info@joeshouse.org
Joe's House website lists accommodations that cater to cancer patients, their families, and caregivers and provides a centralized list of appropriate housing.
  Kristy Lasch Miracle Foundation
Website www.kristylasch.org
Phone 412-872-4125
Email kristylaschmiraclefoundation@comcast.net
The Kristy Lasch Miracle Foundation offers financial assistance to women under 30 living with breast cancer for medical-related expenses.
  The Leukemia & Lymphoma Society Copay Assistance Program
Website http://www.lls.org/copay
Phone 877-557-2672
The Leukemia & Lymphoma Society Copay Assistance Program provides financial assistance (for certain diagnoses) for cancer treatment related co-pays, private health insurance premiums and co-pay obligations, Medicare Part B, Medicare Plan D, Medicare Supplementary Health Insurance and Medicare Advantage premium or co-pay obligations.
  The Lymphoma Research Foundation
Website www.lymphoma.org
Phone 1-800-500-9976
Fax 212-349-2886
Email Helpline@lymphoma.org
The Lymphoma Research Fund (LRF) offers two financial assistance programs for people currently undergoing treatment for lymphoma. Through these programs, LRF may be able to pay a portion of a patient's medical bills or assist with quality of life expenses.
  The SAMFund
Website www.thesamfund.org
Phone 617-938-3484
The SAMFund for young adult survivors of cancer provides direct financial assistance to help young adult cancer survivors recover from the financial impact of cancer treatment.
  Myriad Financial Assistance Program
Website www.myriadtests.com
Phone 800-469-7423
Fax 801-584-3615
Myriad offers testing at no charge to uninsured patients that meet specific financial and medical criteria. Patients who are insured may qualify for financial assistance that limits out-of-pocket expenses. Qualification requirements and application forms are available on the MFAP website and must be filled out by both the patient and provider.
  National Association of Hospital Hospitality Houses
Website www.nahhh.org/
Phone 800-542-9730
Email helpinghomes@nahhh.org
The National Association of Hospital Hospitality Houses (NAHHH), Inc. is an association of nearly 200 non-profit organizations located throughout the U.S. that provide family-centered lodging and support services to patients and their families who are receiving medical treatment far from home. The NAHHH website features an on-line lodging locator.
  National Cancer Coalition
Website www.nationalcancercoalition.org
Phone 919-821-2182
Email Direct from website
NCC helps people who need financial assistance to pay for medicine or added expenses related to medical treatment.
  National Cancer Institute: Financial Assistance
Website www.cancer.gov/cancertopics/coping/financial-legal
Phone 800-422-6237
Email Direct from website
The National Cancer Institute maintains a database of organizations that provide cancer patients and their caregivers with emotional, practical, and financial support services. The database can be searched by type of assistance provided, cancer type, and keyword.
  National Children's Cancer Society
Website http://www.thenccs.org/
Phone 314-241-1600
Email Direct from website
The National Children's Cancer Society provides direct financial assistance for families during treatment.
  National Foundation for Transplants
Website www.transplants.org/
Phone 800-489-3863
Email info@transplants.org
The National Foundation for Transplants (NFT) provides fundraising assistance to bone marrow and solid organ transplant patients in all 50 states and U.S. territories. Through their fundraising program the NFT endeavors to help patients with their transplant, pre-transplant treatment, follow-up care and medications.
  National Organization for Rare Disorders
Website www.rarediseases.org
Phone 203-744-0100
Email RN@rarediseases.org
The National Organization for Rare Disorders (NORD) is a non-profit organization, comprised of a federation of voluntary health organizations dedicated to helping people with rare "orphan" diseases and assisting the organizations that serve them. NORD provides premium and co-pay assistance as well as working with other organizations to provide travel and lodging assistance for study participants enrolled in specific rare disease clinical trials.
  National Patient Advocate Foundation
Website www.patientadvocate.org
Phone (800) 532-5274
Email help@patientadvocate.org
Patient Advocate Foundation (PAF) provides patients with arbitration, mediation and negotiation to settle issues with access to care, medical debt, and job retention related to their chronic/debilitating or life-threatening illness. Their website contains links to many helpful resources for patients and caregivers including a National Financial Resources Guidebook providing an interactive state-by-state database of available financial assistance and resources.
  National Patient Travel Helpline
Website www.patienttravel.org/
Phone 1-800-296-1217
Email info@nationalpatienttravelcenter.org
The NPTC provides a single-point of contact to facilitate patient access to appropriate charitable or discounted airline tickets for patients and patient escorts. The NPTC serves in association with numerous national and state level charitable medical air transportation programs providing maximum efficiency and minimum costs.
  NeedyMeds
Website www.needymeds.org
Phone 800-503-6897
Email info@needymeds.org
NeedyMeds.Com does not supply medications or financial assistance. They provide a comprehensive listing of drugs and dosages that are available through patient assistance programs. They provide detailed information about the patient assistance program including, the program name, contact information, application forms, eligibility guidelines and the application process and requirements.
  Partnership for Prescription Assistance
Website www.pparx.org
Phone 888-477-2669
Email Directly from website
The Partnership for Prescription Assistance offers a single point of access to more than 475 public and private patient assistance programs, including nearly 200 programs offered by pharmaceutical companies.
  Patient Access Network Foundation
Website www.panfoundation.org
Phone 866-316-7263
Email contact@panfoundation.org
The Patient Access Network Foundation is an independent, national organization dedicated to assisting underinsured patients with copayment assistance. Applicants must meet certain financial, medical and insurance criteria. A list of covered disease states is available on their website.
  Patient Services Incorporated
Website www.patientservicesinc.org
Phone 800-366-7741
Email uneedpsi@uneedpsi.org
Patient Services Inc., provides premium and co-pay assistance programs for qualified patients with certain diseases.
  PatientAssistance.com
Website www.patientassistance.com
Phone 888-788-7921
Email Direct from website
PatientAssistance is a non-profit organization providing a patient assistance program database and online enrollment forms (when available through the manufacturer).
  Road to Recovery
Website www.cancer.org/treatment/supportprogramsservices/Road-to-Recovery
Phone 1-800-227-2345
Email Direct from website
Road to Recovery is an American Cancer Society service program that provides transportation for cancer patients to their treatments and home again. Transportation is provided according to the needs and available resources in the community.
  RxAssist
Website www.rxassist.org
Email info@rxassist.org
RxAssist is a national non-profit resource center containing a comprehensive database of patient assistance programs.
  RXHope
Website www.RxHope.com
Phone 877-267-0517
Email CustomerService@RXHope.com
RxHope contracts directly with the Pharmaceutical companies to provide an electronic application process for their patient assistance programs. RxHope provides this service to physicians and patients free of charge. Physicians or their staff members can go online to complete the application. Some applications can be transmitted electronically through the site and others must be printed and mailed or faxed.
  Rx Outreach
Website www.rxoutreach.org
Phone 800-769-3880
Email questions@rxoutreach.org
Rx Outreach is an independent, non-profit charitable organization that offers prescription medicines to uninsured individuals and families, as well as those who have limited prescription drug coverage. Individuals can use Rx Outreach regardless of their age or if they use another discount medicine program or patient assistance program. Financial qualifications and applications are available on the website.
  State Health Insurance Assistance Programs
Website www.shiptalk.org
The State Health Insurance Assistance Program (SHIP) is a national program that offers one-on-one counseling and assistance to people with Medicare and their families. Patients can be referred to their state's SHIP by contacting 1-800-Medicare and asking for health insurance counseling. Patients & others can get state specific information through the SHIP website.
  Sarcoma Alliance
Website www.sarcomaalliance.org
Phone 415-381-7236
Email info@sarcomaalliance.org
The Sarcoma Alliance Assistance Fund reimburses expenses directly associated with getting a second opinion from a sarcoma specialist.
  Supplemental Security Income
Website www.socialsecurity.gov
Phone 1-800-772-1213
Email Direct from website
Supplemental Security Income (SSI) is administered by the SSA and supplements Social Security payments for aged, blind, and disabled people with little or no income. It provides cash to meet basic needs for food, clothing, and shelter. Information on eligibility, coverage, and how to file a claim is available from the SSA. The Benefit Eligibility Screening Tool is available on the website. Individuals who are disabled for 6 months or longer may qualify for benefits. Certain cancer diagnoses qualify.
  Taking Charge of Money Matters
Website www.cancer.org/Treatment/FindingandPayingforTreatment
Phone 1-800-227-2345.
Email Direct from website
The American Cancer Society provides interactive tools dealing with financial and insurance issues that may come up during or after a person's cancer treatment.
  The United Way
Website www.unitedway.org
Phone 703-836-7112
Email worldwide@unitedway.org
The United Way is an international organization that can help patients locate various types of assistance.
  UnitedHealthcare Children's Foundation
Website www.uhccf.org
Phone 855-698-4223
Email customerservice@uhccf.org
The UnitedHealthcare Children's Foundation is a nonprofit charity providing financial assistance in the form of medical grants to be used for medical services for children (16 years and younger) with cancer who are not covered or not completely covered by commercial health benefit plans.
  We Believe Foundation
Website www.wbfinc.org
Phone 240-232-7795
Email Direct from website
The We Believe Foundation provides financial assistance for 15-29 year olds with cancer. Grants include Financial Hardship awards (up to $3,500 per applicant per year), to help cover expenses due to any form of cancer, lost part-time wage grants, and financial assistance for expenses for breast cancer patients.

Published by Rise Marie Cleland. Sponsored by Lilly Oncology

CONTACT US
Risë Marie Cleland Rise@Oplinc.com

Oplinc, Inc.
1325 Officers Row
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Rise@Oplinc.com

UPCOMING ISSUE
Comments and suggestions for future issues are welcome, please forward correspondence to Risë Marie Cleland by email at: Rise@Oplinc.com

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Volume 9, Issue 3
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Volume 9, Issue 1
Volume 8, Issue 4
Volume 8, Issue 3
Volume 8, Issues 1 & 2
Volume 7, Issues 5 & 6
Volume 7, Issue 4
Volume 7, Issue 3
Volume 7, Issue 2
Volume 7, Issue 1
Volume 6, Issues 4 & 5
Volume 6, Issue 3
Volume 6, Issue 2
Volume 6, Issue 1
Volume 5, Issue 6
Volume 5, Issue 5
Volume 5, Issue 4
Volume 5, Issue 3
Volume 5, Issue 2
Volume 5, Issue 1

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ABOUT THE EDITOR
Risë Marie Cleland is the Founder and CEO of Oplinc, Inc., a national organization of oncology professionals. Through Oplinc, Inc., Ms. Cleland publishes the weekly Oplinc Fast Facts focusing on the timely dissemination of information pertaining to billing, reimbursement and practice management in the oncology office and Oplinc’s Best Practices Review, which provides a more in-depth look at the issues and challenges facing oncology practices. Ms. Cleland also works as a consultant and advisor for physician practices, pharmaceutical companies and distributors.

IMPORTANT NOTICES
Please note that this newsletter is presented for informational purposes only. It is not intended to provide coding, billing or legal advice. Regulations and policies concerning Medicare reimbursement are a rapidly changing area of the law. While we have made every effort to be current as of the issue date, the information may not be as current or comprehensive when you review it. Please consult with your legal counsel for any specific reimbursement information. For Medicare regulations visit: www.cms.gov.

CPT® is a Trademark of the American Medical Association Current Procedural Terminology (CPT) is copyright 2014 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein.

Copyright ©2015 Oplinc, Inc.

Oplinc, Inc., grants permission to distribute this newsletter without prior permission provided it is forwarded unedited and in its entirety.

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