- Over 54,000 patients assisted in 2010.
- 21,000 callers assisted each month.
- $144 million+ awarded to patients in 2010.
- Over 150,000 patients helped to date.
Frequently Asked Questions
- When can I speak with someone at HealthWell to get help?
- What services does the Foundation provide?
- Can I receive both premium assistance and copayment assistance?
- Does HealthWell provide assistance for all diseases?
- Do I qualify? What are the HealthWell Foundation eligibility criteria?
- Do uninsured patients qualify for assistance from the HealthWell Foundation?
- I have very limited prescription or health benefits, will I still qualify?
- I am receiving assistance from the manufacturer, can you help me with the balance?
- I have a Health Savings Account (HSA) or Health Retirement Account (HRA), do I qualify?
- Can you help me even if I have a Flexible Spending Account?
- How do I apply?
- How long does it take to process an application? When will I hear if I have been accepted?
- How do I know what I need to do?
- What happens if my physician changes my prescription while I am enrolled in the program? Does the amount of my award change?
- Do you cover the entire copayment or just certain treatments?
- How much financial assistance does the HealthWell Foundation provide?
- If I am approved, how long will I be enrolled?
- What do I use to determine my household income?
- Why would I be audited by the Foundation?
- What are the terms and conditions for the Foundation?
- How do I get reimbursed? What do I submit? Will I receive a check?
- I received a plastic HealthWell pharmacy card with my enrollment letter. How do I use it?
- Are approvals retroactive?
- How do I get information on my grant?
- Can I reapply for help every year?
- What is the impact of health care reform on the HealthWell Foundation?
Important Documents
Statement of TreatmentTerms and Conditions
Reimbursement Request Form
Tips for Working Efficiently with HealthWell
When can I speak with someone at HealthWell to get help?
The HealthWell Foundation customer service phone lines are open from 9:00 a.m. to 5:00 p.m., Monday through Friday, Eastern Time. We are closed on Federal holidays. The best time to call is before 10:00 a.m. You may also use our automated telephone system, send a fax, apply online or visit our web site 24/7 – all at your convenience.
What services does the Foundation provide?
The Foundation provides financial assistance to eligible individuals to cover coinsurance, copayments, healthcare premiums and deductibles for certain treatments. This means that if you've been prescribed a medication and your insurer covers it, but you cannot afford the coinsurance or copayment required, we may be able to help by paying some or all of your costs associated with the medication. Also, if you are eligible for health insurance, but cannot afford the insurance premium, we may be able to help by paying some or all of the medical portion of your insurance premium.
Please keep in mind that the Foundation currently does not assist with the following expenses:
- Coinsurance and copayments for office visits
- Administration or infusion costs
- Medical equipment and supplies
- Medical transportation
- Health insurance premium costs for the entire family
- Deductibles that apply to treatments and services that are not eligible for the approved disease fund
Can I receive both premium assistance and copayment assistance?
On a case by case basis, the Foundation may approve patients for assistance with insurance premiums for one fund and copayments for a second fund.
Does HealthWell provide assistance for all diseases?
At this time, HealthWell Foundation is able to help patients taking treatments only for selected diseases. For an updated listing of diseases, see our Diseases page. The HealthWell Foundation adds new disease funds throughout the year, so please visit this site regularly for the latest information.
Do I qualify? What are the HealthWell Foundation eligibility criteria?
To qualify for assistance, you must meet the Foundation's insurance, income, and medical criteria. If you call us, we can screen you to see if you are likely to qualify. Or, answer a few short questions online and immediately learn whether you are eligible for assistance.
Eligibility criteria include: household income is below 400% of the Federal Poverty Level (somewhat more in cities where the cost of living is higher); the patient is being treated for a specific disease for which funding is available; the patient has insurance that covers the treatment for this disease; and the medication is dispensed in the U.S.
Do uninsured patients qualify for assistance from the HealthWell Foundation?
The Foundation assists uninsured patients who need help paying for their insurance premiums. If you are eligible for an insurance plan that would pay for your treatments, but are having trouble affording the premium, the Foundation may be able to help.
The HealthWell Foundation cannot assist uninsured patients who need help paying the full cost of their treatment. However, the Foundation can refer you to other resources that may be helpful, such as drug manufacturers' patient assistance programs and state prescription assistance programs. See our resources page for more helpful links.
I have very limited prescription or health benefits, will I still qualify?
HealthWell is a charity designed to help patients start and continue therapy. We have caps on all of our funds that are set to help the majority of our patients with a year of therapy assistance. With certain levels of coverage, we would not be able to assist patients with limited prescription or health insurance benefits beyond a month or two of therapy. This is not an effective solution for treatment as most patients will likely stop therapy after our assistance runs out. In addition, it means there is one less patient we can help for an entire year.
Patients with very limited prescription or health benefits are not eligible for assistance through HealthWell. Limited prescription or health benefits include:
- $500 or less annual pharmacy cap
- Greater than 50% coinsurance
If you have very limited prescription or health benefits, we encourage you to go back to the manufacturer of your product(s) and let them know that you do not meet the criteria for assistance under HealthWell.
I am receiving assistance from the manufacturer, can you help me with the balance?
HealthWell is a charity and we focus our assistance on patients with high out of pocket costs. In an effort to help as many patients as possible, we cannot help patients who have $25 or less responsibility after the manufacturer assistance is applied. If your situation changes, you are welcome to contact us again.
I have a Health Savings Account (HSA) or Health Retirement Account (HRA), do I qualify?
HSAs and HRAs are not insurance. To meet the criteria for our program, an insurer MUST pay first. An HRA is a tax exempt trust and cannot be used in conjunction with HealthWell Foundation assistance. An HSA allows businesses to reimburse the cost of health insurance and out-of-pocket medical expenses and cannot be used in conjunction with HealthWell Foundation assistance
Can you help me even if I have a Flexible Spending Account?
As long as you meet all eligibility requirements, we do not require patients to exhaust his/her Flexible Spending Account (FSA) before submitting a Claim under any Grant. However, HealthWell will not pay or reimburse any claim for any service or cost already reimbursed under an FSA. Further, any claim paid or reimbursed by HealthWell cannot also be submitted to a FSA for payment or reimbursement.
How do I apply?
The easiest and fastest way to apply is to complete the application online. Follow the prompts and answer all required fields.
If you do not have access to a computer, please call us at (800) 675-8416 and we will collect the required information for eligibility determination.
If you are pre-approved, either by phone, online or through the website, you MUST submit the following WITHIN 30 DAYS: 1) a Statement of Treatment form, which your physician must complete and sign; and 2) a copy of the front and back of your insurance card AND your pharmacy card (if applicable). For faster service, fax these items to us at (800) 282-7692. If you do not have access to a fax machine, you may mail these materials to: HealthWell Foundation, P.O. Box 4133, Gaithersburg, MD 20878.
Once we have received this information – your Statement of Treatment Form and copies of your insurance and pharmacy cards – we can begin reviewing requests for reimbursement.
How long does it take to process an application? When will I hear if I have been accepted?
We have changed our program to serve you better! You will know the same day you speak with us or apply online whether you are pre-approved or not eligible.
If approved, your grant is held the day of the call or online approval. Eligible Dates of Service (DOS) for reimbursement start the day of the call or online approval.
Following pre-approval, you and your provider have 30 days to submit the complete and signed Statement of Treatment and copies of the front and back of your insurance and pharmacy cards. We must receive ALL the required documentation within 30 days of pre-approval or your grant will close and you cannot re-apply for a grant until the next calendar year.
Until the required documentation is received, we will not process any reimbursements on the grant nor will a pharmacy card be sent.
Once we receive the required documentation, we can begin reimbursing eligible claims back to the pre-approval date and send a pharmacy card (fund appropriate). For pharmacy card patients, any out of pocket costs incurred between the approval date and receipt of the card can be handled via paper claims sent directly to us.
How do I know what I need to do?
After pre-approval via phone or online, we will send you an approval letter with the approval date and grant amount. This letter will be titled "PRE-APPROVED ACTION REQUIRED." This letter outlines the documentation we require and will include a blank Statement of Treatment for the provider to complete. In addition, if you provide us with the name and fax number for the provider contact, we will fax the Statement of Treatment with cover sheet to your provider’s office.
NOTE: this is the only notification sent regarding the required documentation to you and your provider. We will no longer call or send letters requesting any missing required documentation. It is YOUR RESPONSIBILITY to ensure we received the required documentation within 30 days of the approval. We must receive ALL the required documentation within 30 days of pre-approval or your grant will close and you cannot re-apply for a grant until the next calendar year.
Once we have received the required documentation, we will send you a second approval letter titled "APPROVED." This letter will provide the patient with a Reimbursement Request Form (RRF) and instructions for submitting the reimbursement OR a pharmacy card (fund appropriate). In addition, we will fax a copy of the second approval letter to the provider.
What happens if my physician changes my prescription while I am enrolled in the program? Does the amount of my award change?
You are free to change the therapy you are using at any time, as long as your physician has prescribed an eligible therapy for the disease area in which you are enrolled. You are free to switch your treatment, physician, or pharmacy at any time and it will not affect your eligibility for assistance or change the amount of your award.
Do you cover the entire copayment or just certain treatments?
The Foundation pays only copayments related to prescription or biologic treatments you are taking specifically for the medical condition listed in your application.
How much financial assistance does the HealthWell Foundation provide?
The HealthWell Foundation provides full or partial assistance with eligible out-of-pocket health care expenses. The amount of assistance you receive will depend on your income, your insurance coverage, the amount of funding we have available for assistance, and other factors. Upon approval, you will receive a letter telling you how much assistance you are eligible to receive.
If I am approved, how long will I be enrolled?
All grants end December 31st. Re-enrollment begins the first business day of December by calling us at (800) 675-8416. If you would like to re-enroll, please call or email us about one month before your grant ends to begin your re-enrollment process. Please remember that the Foundation grants assistance on a first-come, first served basis to the extent that funding is available and receipt of prior grant approval does not guarantee subsequent grant approval.
In order for patients to remain eligible for assistance from the Foundation, we must receive the first complete reimbursement request within 60 days of the enrollment start date, and continue to receive a complete reimbursement request at least every 60 days. Grants with no activity for over 60 days will be considered inactive and closed and you cannot re-apply for a grant until the next calendar year. The HealthWell Foundation cannot guarantee future availability of funds once a grant has been closed due to inactivity.
What do I use to determine my household income?
The HealthWell Foundation is only able to assist individuals who make less than a certain income, and we require proof of your family’s income to determine whether you are eligible for assistance. Specifically, your household's adjusted gross income must be below 400% of the Federal Poverty Level, or somewhat more in cities where the cost of living is higher. For example, a family of 2 can earn a total household income of up to $58,280 (or slightly more in some high cost cities) and qualify for assistance.
To calculate your household income for the purpose of applying to HealthWell, please consider the following source of income:
- Employment (yourself and spouse/partner, if any)
- Pension (yourself and spouse/partner, if any)
- Supplemental Security Income (SSI-Social Security non-disability)
- Social Security Disability Income (SSDI)
- Unemployment Benefits
- Workers Compensation Benefits
- Aid from the Department of Public Welfare
- Alimony (does not apply if applicant is a child)
- Child Support (only applies if applicant is a child)
- Dividends, interest, or investment accounts
- Other (family, friends, other charities)
If you do not have access to a computer, please call us at (800) 675-8416 and we will collect the required information for eligibility determination.
Why would I be audited by the Foundation?
In an effort to be the best stewards of our donated dollars and serve the most patients possible, we invested in a state-of-the-art fraud detection system and have new auditing flags and procedures in place.
Starting in June, when you use your pharmacy card for the first time or submit any paperwork for reimbursement, you will have accepted and be bound by all terms and conditions outlined in your patient approval letter. Every patient will now be subject to a random fraud audit. Accounts will be heavily audited on a daily basis and at any time you could be asked to produce verification of any information you verbally provided to the foundation in support of your grant application.
What are the terms and conditions for the Foundation?
The terms and conditions will be printed on the back of all approval letters beginning June 13, 2011 and will outline the parameters of the program related to your grant and receiving reimbursement.
How do I get reimbursed? What do I submit? Will I receive a check?
Once we receive all required documentation, you will receive a Reimbursement Request Form in the mail with your second approval letter. You must submit a Reimbursement Request Form, along with an invoice and proof of payment, each time you have an out-of-pocket cost for an eligible medication. If you have not yet paid the copayment or premium, please indicate this on the Reimbursement Request Form, and we will mail the payment directly to your pharmacy, physician, or insurer. If you have already paid the premium or copayment, the Foundation will send the reimbursement check to you. Please note, if you have already paid for the medication and need to be reimbursed, you must include proof of payment with the Reimbursement Request Form. Proof of payment includes a copy of a canceled check, a credit card receipt or statement, or an itemized receipt from the pharmacy or doctor listing the drug purchased. Many times we are able to coordinate billing with your pharmacy or physician. In these cases, we will send the award payment directly to them after you have received your medication. Please ask your pharmacy or physician’s office to contact us to discuss a direct billing arrangement.
Depending on the disease fund you are enrolled in, you may also receive a HealthWell pharmacy card . If so, please see the next question.
I received a plastic HealthWell pharmacy card with my enrollment letter. How do I use it?
Bring the HealthWell pharmacy card with you to the pharmacy when you fill your prescription, or call your mail order pharmacy and provide the numbers on the card. The card is similar to an insurance card and your pharmacist should be able to use it to pay your copayment for your treatment. If your pharmacist has questions about how to use the HealthWell card, please ask him or her to call the pharmacist telephone number on the back of the card. If you received a HealthWell card but receive your treatment at your doctor's office, you will not need to use the plastic pharmacy card (but save it just in case you need it later). Instead, please give your physician a Reimbursement Request Form, which you received with your enrollment letter, and ask him or her to mail it to us with an invoice that shows the cost of your treatment.
Are approvals retroactive?
If approved, the patient grant is held the day of the call or online pre-approval. Eligible dates of service (DOS) for reimbursement start the day of the call or online approval. NOTE: We are no longer offering 90 day retroactive reimbursement.
How do I get information on my grant?
You can check on your grant any time by using our automated telephone menu system at (800) 675-8416.
Through the automated system, you can:
- Check whether or not required documentation has been received
- Verify the grant start date, end date, and available grant balance
- Learn about the most recent 3 payments – dates of service and amounts
- Receive an overview of our eligibility criteria
- Once a pharmacy card has been issued, obtain pharmacy-needed details:
- Member number
- Group number
- BIN
Can I reapply for help every year?
Yes. All active patients are welcome to re-enroll in December as long as the patient still requires assistance, meets the program criteria and funding is available.
What is the impact of health care reform on the HealthWell Foundation?
On March 21, 2010, the Patient Protection and Affordability Care Act was signed into law. We know many of our patients have questions concerning what this historic legislation means for the HealthWell Foundation. The short answer is that the HealthWell Foundation plans to be here for a long time, continuing our mission to reduce barriers to care for underinsured patients with chronic or life-threatening diseases.
Over the next decade, we anticipate the demand for copayment and premium assistance actually will rise, particularly as more of the uninsured get health insurance. Through the generosity of our donors, the HealthWell Foundation will continue to assist our patients with their prescription coinsurance, copayments, and deductibles, as well as healthcare premiums.
This year, the health care reform will begin to help Medicare Part D Patients who reach their coverage gap or “doughnut hole” by providing a $250 rebate to help pay for their prescription drugs. The HealthWell Foundation realizes that patients have many health care expenses and that we are not able to offer assistance for many of these costs. Therefore, we are happy to know that some patients will receive this additional $250 resource, and we will not ask any of our grant recipients to return this money to the Foundation.
We will continue to update our website as we learn more about health care reform. Also, we encourage our patients to learn as much as they can about this new legislation and how it will affect them. For more detailed information, please visit the following websites:
- The Henry J. Kaiser Family Foundation - http://healthreform.kff.org
- U.S. Department of Health & Human Services - http://www.healthreform.gov
- The National Consumer Voice For Quality Long-Term Care - http://www.nccnhr.org/advocate/health-care-reform
Disclaimer: The HealthWell website contains links to certain websites that are not affiliated with their foundation. These may include State and Local governmental agencies, international agencies, and private entities. The HealthWell Foundation cannot attest to the accuracy of information provided by such websites. If we provide a link to such a website, this does not constitute an endorsement by The HealthWell Foundation or any of its employees of the information or products presented on the website. Also, such websites are not within our control and may not follow the same privacy, security or accessibility policies. Once you visit such a website, you are subject to the policies of that site.
Other questions? Please contact us.