Download the Assistance Application

Assistance Application

Financial Assistance is available to cystic fibrosis patients who attend a qualified cystic fibrosis care center.

 

Eligibility Guidelines

  • Patient is diagnosed with Cystic Fibrosis.
  • Patient is followed by a qualified cystic fibrosis care center.
  • Evidence of financial need.
  • Patient and/or family has explored other options of financial assistance.

Application Procedure

  • Download and complete the entire application.
  • Provide documents to support the requested assistance. Copies of the CURRENT bill and/or EOB (Explanation of Benefits) must be attached.
  • Do not leave any field blank. If it does not apply, please put n/a.
  • Incomplete request or missing information will be automatically denied.
  • Send completed application to the social worker at the qualified cystic fibrosis care center.
  • DO NOT CONTACT Reaching Out Foundation Directly.
  • All request will be reviewed and approved by the social worker. The Foundation has the final approval.
  • The requesting social worker will be notified regarding the review decision. Please allow 5 business days after the CFROF receives the application to process the payment.
  • Checks are only written and paid directly to the vendor.
  • Reaching Out Funds should be used as a last resort. Social Workers are required to review all request for alternative funding.
  • Genetic testing, funeral expenses, collection agency bills and credit care bills are not covered. We also do not pay late fees. The non-covered list is not all inclusive. Other request may be denied by the board. Request may not be approved due to lack of funding.
  • Dollar limits apply.

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