Get Reimbursed

The HealthWell Foundation strives to ensure that as much of our funding as possible goes directly to assisting patients. Reimbursement requests that are $5.00 or less will not be reviewed or considered for payment.

When the Foundation approves a grant, we will send the patient a Reimbursement Request Form with the enrollment letter. The patient, pharmacy or provider must submit a Reimbursement Request Form along with supporting documentation each time the patient has an out-of-pocket treatment expense.

1. Reimbursement Request Form: Click here for a copy of this form.
2. Supporting Documentation: Providers should include an Explanation of Benefits from the insurer with the patient's name, date of service, eligible drug name or code, and copayment amount. Pharmacies or patients may send either an insurance Explanation of Benefits or a pharmacy receipt that includes patient name, date of service, eligible drug name or code, and copayment amount.
3. Proof of Payment: If the Foundation is reimbursing the patient for a claim he or she already paid, also attach proof of payment showing the method and date of purchase.

Premium Assistance

For premium assistance, please send a copy of the insurance premium invoice that clearly shows the cost only for the individual patient.

HealthWell Pharmacy Card

For some disease funds, we are able to send patients a HealthWell pharmacy card. Patients should bring the HealthWell pharmacy card to the pharmacy when they fill their prescriptions, or call their mail order pharmacy and provide the numbers on the card. The card is similar to an insurance card and the pharmacist should be able to use it to pay the copayment for the treatment. If the pharmacist has questions about how to use the HealthWell card, he or she should call the pharmacist telephone number on the back of the card.

Helpful Tips

• The Foundation will not review or consider for payment reimbursement requests that are $5.00 or less.
• Please submit your claims as soon as possible. We must receive a claim at least once every 60 days or the grant will close and the patient cannot re-apply for a grant until the next calendar year.
• We will not pay any claim that we receive more than 120 days after the date of service.
• Once we receive a complete reimbursement request, you should receive a reimbursement check in approximately 2-3 weeks.