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United Virginia Chapter of the NHF Family Assistance Program

Purpose
To improve the quality of life for individuals/families with bleeding disorders by providing financial support, based on availability of funding, to help pay for:

• Expenses incurred in the care, treatment, or prevention of a bleeding disorder such as, transportation to clinic or hospital, medic alert bracelets, and related expenses are a priority.
• Other basic living expenses will be considered on a case by case basis and may include dental expenses, assistance with utility expenses, rent, etc.
Note: Because of the time-line in processing these requests, these funds cannot be considered for most emergency related expenses. Every effort should be made to utilize other community resources such as PSI (Patient Services Inc, Social Services, food banks and other organizations that routinely meet these types of needs. This program is intended to help individuals and families after other sources of assistance have been exhausted or unavailable.

Eligibility
Successful applicants will meet the following criteria:

1. Resident of the defined geography of the United Virginia Chapter of NHF or receive treatment for bleeding disorders at any of the three area HTC’s (CHKD, VCU Med Ctr. or UVA Med Ctr.)
2. Parent or caregiver of an individual living in your home or an individual with a diagnosis of: A bleeding disorder, the treatment and care of which is within the mission and purpose of the United Virginia Chapter as determined by the Executive Director in consultation with the Executive Board.
3. Complete all sections of the application thoroughly and accurately in order for UVC/NHF to review the request. If a question does not apply, it should be marked not applicable (n/a). Failure to provide complete and truthful information may result in denial of your request.
4. Coordinate request with Social Worker/Nurse Coordinator at a hemophilia treatment center or other healthcare provider treating bleeding disorders.

Administration


1. Funding Assistance is not guaranteed and is dependent upon availability of funds. Payment of funds upon approval cannot be guaranteed earlier than two weeks, and may take longer, from the date of the request due to committee logistics.
2. Disbursements will be monitored and reported with names omitted to the Board of Directors.
3. Assistance is limited to twice per calendar year unless special circumstances are presented.
4. The assistance amount has been set at $250. per request.
5. The application will be reviewed as an “identity blinded” document by the current “Family Assistance Committee”. However, circumstances may require that the documents may be processed by the chapter Treasurer, President and/or Executive Director.

Confidentiality


1. All applications and information pertaining to funding requests are considered confidential to the extent permitted by applicable law.
2. Aggregate data on the Family Assistance Fund will be available, but will not include the names or any identity information.

Request Process

1. Applications are available by contacting Jeff Krecek, Treasurer at 434-295-9515 (evenings) or through your treatment center. If you have any questions call 1-800-266-8438.
2. Requests can be received by Treasurer, Jeff Krecek either from the treatment center, physician or directly from the patient/family.
3. In order to facilitate your request, it is highly recommended, if possible, that you review your application with the social worker or nurse coordinator at your hemophilia treatment center. The treatment center can review and forward your application to the UVC/NHF.
4. Before payment can be issued, a bill must be submitted with the request.
5. All identifying information is removed and the facts of the request are sent to the Family Assistance Review Committee Chair or directly to the entire committee as deemed practical.
6. The committee chair contacts the other members of the committee to discuss the request and make a decision.
7. The decision is communicated to the treasurer who in turn notifies the appropriate treatment center or person making the request.
8. The treasurer ensures that the patient/family requesting assistance is not chronically abusing the system.
9. Any request that is approved is generally paid/endorsed directly to the company owed the payment such as phone, utility or mortgage company. Copies of the request, bills and payments will be kept on file.

A copy of the Needs Assessment form is available here.