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Financial Assistance Program Guidelines

Financial Assistance Program Guidelines

Purpose:

The Bleeding Disorders Foundation of North Carolina (BDFNC) Financial Assistance Program is part of BDFNC’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, and/or
  • Basic living expense emergencies.

Note: This program is intended to help individuals and families who have exhausted all other sources of assistance and for whom no other funds are available.

Eligibility:

To be eligible for this program you must meet the following criteria:

  • You must be a resident of North Carolina; OR receive treatment from one of the five (5) federally funded Hemophilia Treatment Centers (HTCs) within North Carolina: the Wake Forest University School of Medicine, the University of North Carolina at Chapel Hill School of Medicine, the East Carolina University Brody School of Medicine, the Hemophilia Treatment Center of Levine Cancer Center and Levine Children’s Hospital, and the St. Jude Affiliate Clinic at Novant Health Hemby Children’s Hospital.
  • You must be the parent or caregiver of a minor child who lives in your home and who has a diagnosis of a bleeding disorder; OR be an individual with a diagnosis of a bleeding disorder. If the person with a bleeding disorder has died, their surviving spouse, partner, parent, adult child, or caregiver can make a one-time application for financial assistance provided that: the application is made no more than six months after the date of death; AND the deceased person can be verified to have been a member of the applicant’s household for at least one year up to the date of death.
  • You must have requested assistance from TWO (2) other agencies before applying to BDFNC, and provide contact information for those agencies and the status of your requests.
  • You must complete all sections of the application thoroughly and accurately. (If a question does not apply, it should be marked Not Applicable [N/A]).
  • Because of limited funds, BDFNC reserves the right to take into consideration whether an applicant has been a “no show” as defined in its Event Registration and Attendance policy.
  • Exceptions: BDFNC employees and members of the BDFNC Board of Directors are not eligible for financial assistance.

Administration:

  • Financial assistance depends on the availability of funds and applicant eligibility. Funding is not guaranteed. Applicants should allow at least two weeks for BDFNC to process their request. Please do not inform creditor of payment until application has been approved.
  • Assistance is limited to a maximum of $500 per calendar year. BDFNC assistance is limited to two consecutive years. After two years, applicants must wait one year before applying again for assistance. In the presence of special circumstances, the BDFNC Board of Directors will review exceptional requests.
  • Disbursements will be made only to creditors identified in the application and that have been verified by BDFNC. No payments will be made directly to applicants.

Request Process:

  1. Application forms are available by calling the BDFNC office at 800-990-5557, by emailing a request to info@hemophilia-nc.org, or by downloading from www.hemophilia-nc.org.
  2. Completed applications and a copy of the bill must be submitted by mail to: Hemophilia of North Carolina 260 Town Hall Drive, Suite A Morrisville, NC 27560 or faxed to (919) 319-0016.
  3. The BDFNC staff will review applications for completeness, check references, and consider the date the funds are needed in order to determine the urgency of the request.
  4. Applications should be submitted directly to the BDFNC office by the applicant. If this is not possible and it is necessary for another person to submit the application on behalf of the applicant, BDFNC representatives will contact the applicant before the application will be processed.
  5. BDFNC strongly encourages applicants to coordinate their request with the social worker (or nurse coordinator) at their hemophilia treatment center or other healthcare provider treating bleeding disorders.
  6. Incomplete applications will be returned to the applicant with an explanation of why it was returned and a description of the information still required.
  7. Complete applications will be sent to the Financial Assistance Committee for review.
  8. If the application is approved, BDFNC staff will notify the applicant, and payment will be issued to the creditor identified on the application.
  9. If the application is rejected, BDFNC staff will notify the applicant with an explanation.
  10. BDFNC staff will update its Financial Assistance Program records and add the applicant to the BDFNC database for future communications.

Confidentiality:

  • Applications and information pertaining to funding requests are considered confidential.
  • Information from BDFNC 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.
  • 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 BDFNC.