Appeal letter sample: Financial Resources
Template letter for professionals to provide to IBD patients information on finanicial assistance programs. Letter provides information on financial and medication assistance programs.
SAMPLE LETTER BELOW
RE: Financial Resources
(During our last conversation) or (During your last office visit) you mentioned that you were having difficulty paying for your medication (or) co-payments.
Obtaining financial assistance to cover all health costs can be challenging for those who need it most. If you need help paying for medication or insurance co-payments, there are several things to look into.
In some cases, pharmaceutical companies offer patient assistance programs which provide help to those who need financial support in paying for their medication. Please note these programs usually apply to those who are uninsured. To find information on the various patient programs providing assistance for specific medication, the links are: www.needymeds.org (215.625.9609) or www.rxassist.org (401.729.3284)
In addition if you have insurance that requires co-pays that may be too costly, the Patient Access Network Foundation provides financial assistance to people diagnosed with Crohn’s disease who cannot afford the out-of-pocket expenses associated with their insurance coverage. For further information on the fund and the application process, their contact phone number is 1-866-316-PANF (7263). A similar program is offered through the Patient Advocate Foundation for Crohn’s and ulcerative colitis patients, www.copays.org, 1-866-512-3861.
Also the Modest Needs Foundation provides one-time emergency grants to financially needy families or individuals. For more information on this foundation you can visit: www.modestneeds.org
Additionally, if necessary you can get free or low cost medical treatment at community health centers, which are funded mostly by the federal government. You can find the centers in your area at this link: http://ask.hrsa.gov
For information on ostomy supply assistance you may contact the following organizations:
- The Ostomy Group: W: www.ostogroup.org , E: firstname.lastname@example.org , P: 530.432.9607
- Friends of Ostomates Worldwide: W. www.fowusa.org, E: email@example.com
- United Ostomy Associations of America, Inc (UOAA): W: http://www.uoaa.org/ , P: 800-826-0826
- Convatec- Access Program: P: 800-979-8716
- Hollister: www.hollister.com , P: 888-740-8999
If, after reviewing the information and you have further questions, you can contact the Crohn's & Colitis Foundation of America at 1.888.MY.GUT.PAIN (694-8872) or firstname.lastname@example.org to get more information on medication and health insurance resource information.
For further information, call CCFA at our Information Resource Center: 888.MY.GUT.PAIN (888.694.8872).
The Crohn’s & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization’s resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.
About this resource
Published: May 1, 2012
Financial Resources (.doc)
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