THINGS WE HELP COVER INCLUDE:
Pharmacy prescriptions not covered by insurance (Copy of the invoice from the pharmacy including account number/name, company payment address – include exact amount you’d like paid)
Medical procedures not covered by Insurance but requested by Physician (Please submit letter to confirm)
Insurance premiums (COBRA included) (Copy of bill including account number/name and company payment address– include exact amount)
Insurance co-payments (Copy of bill including account number/name and company payment address– include exact amount))
Nutritional assistance (Include exact amount)
Durable medical equipment (Copy of bill including account number/name and company payment address– include exact amount you’d like paid)
Transportation costs (Would apply to an unpaid hotel bill for a stay related to medical treatments. Copy of invoice including account number/name and company payment address-include exact amount)
2. Applications are reviewed by the Shelly Sachs Foundation Board Members for completeness and whether the patient meets eligibility criteria. If the patient is approved for assistance, the applicant is notified by phone or email regarding the amount of assistance. Financial Assistance checks are made directly to the creditor owed.
3. Eligibility Criteria
APPLICANTS MUST MEET THE FOLLOWING QUALIFICATIONS TO BE CONSIDERED FOR AID.
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Must be at least 18 years old.
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Must have a cancer diagnosis as certified by healthcare provider.
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Must be in active treatment or within a six month period of cancer treatment.
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Patient declines active treatment and is admitted to hospice services.
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Demonstrate attempts to apply for other forms of community financial assistance.
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List other agencies from which you have requested funding.
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Financial assistance will be considered for applicants that meet the aforementioned qualifications
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Payments will be made directly to company owed. Therefore, applicants must supply copies of the bill, late notice, mortgage statement, statement from landlord and his/her contact information, or any additional information necessary for grant payment.
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Applicants must be referred by a physician, physician assistant, nurse, social worker, or patient account representative.
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We cannot pay bill via credit card.
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Only completed applications will be considered.