VHF's Financial Assistance Program

VHF Financial Assistance Program Request For Services Form (online)»

VHF Financial Assistance Program Request For Services Form (download pdf)»

Financial Assistance Program Guidelines (Updated June 20, 2024)

Purpose

To improve the quality of life for individuals/families with inherited 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 timeline in processing these requests, these funds cannot be considered for urgent requests. Every effort should be made to utilize other community resources such as 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 and for one-time emergency needs. This program is not meant to be used to remedy chronic financial problems.

Eligibility

Successful applicants will meet the following criteria:

1. Reside within the Virginia Hemophilia Foundation’s (VHF) coverage area, which includes the cities and counties of the Commonwealth of Virginia, other than the cities of Alexandria, Fairfax, Falls Church, Herndon, Manassas, Manassas Park and Vienna and the counties of Arlington, Fairfax, Fauquier, Loudon, Prince William, and Stafford or receive treatment for an inherited bleeding disorder at any of the three area Hemophilia Treatment Centers (HTC’s) (CHKD, VCU Med Ctr. or UVA Med Ctr.)
2. Be an individual diagnosed with an inherited bleeding disorder and/or parent/caregiver of a minor child who lives in your home and is diagnosed with an inherited bleeding disorder that is within the mission and purpose of VHF as outlined by the Board of Directors.
3. Complete all sections of the application thoroughly and accurately. 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 requests with a Social Worker and/or 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.
2. Disbursements will be monitored and reported with names omitted to the Board of Directors.
3. The assistance amount is limited to $500 per year. However, additional support may be requested if there are extenuating circumstances.
4. The application will be reviewed as an “identity blinded” document by the current Financial Assistance Committee. However, circumstances may require that the documents be reviewed by a member of VHF’s Executive Committee.

Confidentiality

All applications and information pertaining to funding requests are considered confidential to the extent permitted by applicable law.

Aggregate data on the Financial Assistance Fund will be available but will not include the names or any identifying information.

Request Process

Go here to apply online. If you have any questions call 804-740-8643.

1. Applications are available from VHF or through your treatment center.
2. Requests can be received by the local HTC’s, other healthcare providers treating inherited bleeding disorders, and/or directly from the patient/family.
3. To facilitate your request, it is highly recommended that you review your application with the social worker or nurse coordinator at your hemophilia treatment center or other healthcare provider. The treatment center or other healthcare provider can review and forward your application to VHF.
4. All identifying information is removed and the facts of the request are sent to the Financial Assistance Committee.
5. The decision is communicated to the Executive Director and/or other identified VHF Staff person or Executive Committee member who in turn notifies the appropriate treatment center or person making the request.
6. The Executive Director and/or other identified VHF Staff person or Executive Committee member ensures that the patient/family requesting assistance is not chronically abusing the system.
7. Before payment can be made, a bill must be submitted with the request.
8. 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.