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Helping Hands Medical Travel Referrer

HFA understands that families affected by inhibitors are faced with unique medical and financial needs. The inhibitor community is challenged with bleed management, joint damage, venous access issues, pain issues, and social and emotional concerns. In addition to this is a great financial burden. Families affected by inhibitors miss time from school/work, are hospitalized frequently, and face mounting medical bills. HFA鈥檚 Inhibitor Support provides a safety net for families in need. All households affected by inhibitors are also eligible to apply for other HFA Helping Hands Programs including聽Emergency Assistance andItems Assistance.

Eligible households can apply for assistance with the following:

  • Medical Travel 鈥 Assistance for travel/lodging for medically necessary procedures, surgeries, and/or second opinions
  • Tutoring/Educational Supplies 鈥 Assistance with the cost of tutoring or supplies for students who have missed school due to inhibitor-related complications

Fitness support is discontinued as of January 1, 2021. HFA understands the importance of fitness support and we encourage community members to explore HFA’s Learning Central Joint Health Module (in the Health & Wellness Center) to keep your fitness routine going strong with items you likely have at home!聽

HELPING HANDS REFERRAL FORM


Please read carefully before proceeding.*

Eligibility Requirements:

  • Eligible households must include at least one member with a diagnosed bleeding disorder
  • Eligible households must include at least one member with an active inhibitor: a measurable titer and/or shortened half-life
  • Must demonstrate financial need
  • Travel arrangements must be made at least 30 days prior to the requested medical visit

NOTE: Inhibitor Support cannot cover any legal or medical expenses including medical bills, dental bills, insurance premiums, co-payments, deductibles, medications, factor, etc. Helping Hands no longer assists with educational travel, so please contact the organizers of the conference you’re attending to find out about financial aid. Helping Hands no longer assists with fitness support, but we聽encourage community members to explore HFA’s Learning Central Joint Health Module (in the Health & Wellness Center) to keep your fitness routine going strong with items you likely have at home! Visit HFA’s Patient Assistance Portalto find other financial resources.

Steps to Apply:

  1. Complete a Helping Hands referral online (click red button).
    -Referrals can be submitted by the applicant or a professional representative**聽 in the bleeding disorders community聽(healthcare provider, social worker, homecare/specialty pharmacy, local bleeding disorder organization).
    -If the need is time-sensitive, please specify why and when needed.
  2. Obtain written documentation from a healthcare provider(doctor, nurse, physical therapist).聽Documentation can be in the form of a letter, medical visit notes, or聽this聽medical verification form,聽can be uploaded in the referral portal or emailed to helpinghands@hemophiliafed.org and must confirm:
    A. Diagnosis of bleeding disorder and active inhibitor (a measurable titer and/or shortened half-life) AND
    B. Specific reason for request and how it will support the patient鈥檚 inhibitor treatment (e.g. confirmation of appointment for medical travel or confirmation of need for educational support).
  3. Complete and submit the appropriate form for Tutoring/Educational Supplies Reimbursement, or聽Medical Travel Reimbursement.
  4. Upload all documentation in the referral form or email to helpinghands@hemophiliafed.org.
    -Once the referral is complete and all documentation received, a Helping Hands staff member will contact the applicant to collect/confirm application information and convey the approval decision. This process is usually completed within 30 days.
    -Referrals are reviewed in order received unless a time-sensitive need is specified in the referral.

*Please contact HFA at 202-675-6984 or helpinghands@hemophiliafed.org with any questions.
**A referral indicates permission to contact both the applicant and the referrer. We will be in touch with the referrer or a local professional about any safety issues raised in our phone interview.

HELPING HANDS REFERRAL FORM

 

 


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