DISTRIBUTION PROGRAM
Program Description:
This program will provide financial assistance for individuals diagnosed with cancer and is available to individuals in the Hermann (Gasconade County R-1) School District facing financial difficulty as a result of their diagnosis and resulting treatments. This assistance would be for expenses not covered by health insurance.
Each applicant will fill out the attached application, submit a physician’s statement regarding their cancer and course of treatment along with a copy of the medical authorization form. The applicant must have the application and medical authorization duly notarized.
The Hermann Area Crusade Against Cancer Review Council, which is comprised of health care, social service, and insurance professionals and other members of the community, will review each request for assistance in a timely fashion.
Program Criteria/Guidelines:
The applicant must be a Missouri resident residing within the boundaries of the Hermann (Gasconade County R-1) School District. Individual consideration of each application will be done on a case-by-case basis and is subject to availability of funds.
Residency: The applicant must be a Missouri resident residing within the boundaries of the Hermann (Gasconade County R-1) School District.
Age: Applicants of all ages will be considered for the program.
Insurance: Applicants may be insured, uninsured, receiving Medicaid benefits, or Medicare benefits.
Personal information: Applicants may be asked to share information related to their diagnosis. Personal information will also help determine if there are other community resources that would benefit the applicant and/or family. These include the Food Pantry, Ministerial Alliance, Community Action Agencies, HUD Housing, OATS and The American Cancer Society.
Medical Information | Verification: Applicants will be asked to share their physician-related information. A signed and notarized medical release, in compliance with Health Insurance Portability and Protection Act (HIPPA) guidelines, is also required. This release should be submitted to the applicant’s physician by the applicant to obtain verification of a cancer diagnosis and current and/or expected treatment.
For Approved Applicants:
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Applicants are approved for up to $5,000 starting with the approved date of the application
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Payments directly to the vendor are preferred; examples may include: pharmacy bills, cosmetic devices, nutritional supplements, housing expenses, utilities, and co-pays.
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Payments to individuals may be made only in instances, such as co-pays, medical bills, pharmacy bills, and hotel/motel expenses, with documented expenses, and meals are reimbursed with appropriate documentation. Payments are not made for cable tv, phone, ATM costs or credit card expenses.
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Payments for expenses outside Missouri cannot be made. Excellent diagnostic and treatment facilities are available in-state to meet these needs.
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Only payment for expenses incurred on and after the application approval date will be eligible.