Frequently Asked Questions
Which services does HealthWell provide?
The HealthWell Foundation provides financial assistance to eligible individuals to cover coinsurance, copayments, health care premiums and deductibles for certain medication and therapies. If you've been prescribed a medication and your insurance company covers it, but you still cannot afford the coinsurance or copayment required, we may be able to help you by paying for part 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 with your insurance premium.
Please keep in mind that the HealthWell Foundation currently does not assist with the following expenses:
- Office visits
- Administration or infusion costs
- Medical equipment and supplies
- Medical transportation
- Health insurance premium costs for an entire family
- Deductibles that apply to treatments and services that are not eligible for your approved disease fund
- Pharmacy compounding costs
- Over-the-counter treatments
- Treatments for side effects (e.g. nausea)
What are the terms and conditions for the HealthWell Foundation?
The terms and conditions are printed on the back of all approval letters and outline the parameters of the program related to your grant and receiving reimbursement.
Does HealthWell provide assistance for every illness?
At this time, the HealthWell Foundation is able to assist patients receiving treatments only for selected diagnoses. The HealthWell Foundation adds new funds throughout the year, so please visit this site regularly for the latest information.
Do I qualify for a grant? What are the HealthWell Foundation's eligibility criteria?
To qualify for assistance, you must meet HealthWell'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 below 400% of the Federal Poverty Level (somewhat more in cities where the cost of living is higher); the person is being treated for a specific disease for which funding is currently available; the person has insurance that covers the treatment for this disease; and the medication is dispensed in the United States.
What if I don't have any insurance?
The HealthWell 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, HealthWell may be able to help.
The HealthWell Foundation cannot assist uninsured patients who need help paying the full cost of their treatment. However, HealthWell can refer you to other resources that may be helpful, such as drug manufacturers' patient assistance programs and state prescription assistance programs. See HealthWell's 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 people start and continue therapy. We have caps on all of our funds that are set to assist 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 company that makes my medicine, can you help me with the balance?
HealthWell is a charitable cost-sharing program 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), can I still get a grant?
HSAs and HRAs are not insurance. To meet the criteria for our program, an insurance company must be the first payor of your claim. 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 as this could result in a claim being paid twice, a practice commonly known as "double-dipping."
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 your application online. Simply follow the prompts and answer all required fields to continue through the application until you are done.
If you do not have access to a computer, please call us at (800) 675-8416 and we will collect the required information over the phone. Or, you may have a friend or relative with a computer apply on your behalf as long as you give them permission.
Once you are pre-approved, whether by phone or online, you must submit the following within 30 days:
- a Statement of Treatment form, which your physician must complete and sign
- a copy of the front and back of your insurance card and your pharmacy card (if applicable). For fastest service, you may fax these items to us at (800) 282-7692
Once we have received this information – your Statement of Treatment Form and copies of your insurance and pharmacy cards – we can begin reviewing your requests for reimbursement so you can be promptly paid.
How long does it take to process an application? When will I hear if I have been accepted?
You will know the same day you speak with us, or apply online, whether you are pre-approved or ineligible based upon the answers you provide. Please be sure to understand that pre-approval means that we still need a few things from you so you can be fully approved to begin using your grant.
If pre-approved, your grant money is held the day of your call or online approval. Eligible Dates of Service (DOS) for reimbursement start the day of the call or online pre-approval.
Following pre-approval, you and your doctor 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. You are welcome to re-apply, however your approval date will reset.
Until the required documentation is received, we cannot process any reimbursements on the grant and a pharmacy card cannot 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.
Can I receive both premium assistance and copayment assistance?
On a case by case basis, HealthWell may approve patients for assistance with insurance premiums from one fund and copayments from a second fund, but never both types of assistance under one fund.
How much financial assistance does the HealthWell Foundation provide?
Each fund is capped in order to provide help to more patients. Upon approval, you will receive a letter telling you how much assistance you are eligible to receive.
Do you cover my entire copayment or just certain treatments?
The HealthWell Foundation pays only copayments related to prescription or biologic treatments you are taking specifically for the medical condition listed in your application.
What happens if my physician changes my prescription while I am enrolled in the program? Does the amount of my grant 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.
How do I know what I need to do?
After pre-approval via phone or online, we will send you a pre-approval letter with the pre-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 a provider to complete. In addition, if you provide us with the name and fax number of the provider contact, we will fax the Statement of Treatment to your provider’s office.
NOTE: this is the only notification sent regarding the required documentation to you and your provider. It is your responsibility to ensure that we receive 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. You can re-apply, however your approval date will reset and all reimbursements run from the most recent pre-approval date.
Once we have received the required documentation, we will send you a second letter titled "APPROVED." This letter provides each grant recipient with a Reimbursement Request Form (RRF) and instructions for submitting the reimbursement. For certain funds, a pharmacy card may be sent as well. In addition, we will fax a copy of the approval letter to the provider.
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 (not just you) 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 one of our representatives will collect the required information for eligibility determination.
If I am approved, how long will I be able to receive support?
All grants end December 31st. Re-enrollment begins the first business day of December and you may call us at (800) 675-8416 to begin the process. Please remember that HealthWell 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 HealthWell, we must receive the first complete reimbursement request within 90 days of the enrollment start date, and continue to receive a complete reimbursement request at least every 90 days. Grants with no activity for over 90 days will be considered inactive and closed, however you may continue submitting payment requests. HealthWell cannot guarantee future availability of funds once a grant has been closed due to inactivity.
Why would I be audited by the HealthWell Foundation?
In an effort to be the best stewards of our donated dollars and to serve the most patients possible, we use in a multi-faceted fraud detection system and have numerous fraud auditing flags and procedures in place.
When you use your pharmacy card for the first time or submit any paperwork for reimbursement, you will have accepted and agreed to be bound by all terms and conditions outlined in your patient approval letter. Every patient is 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 HealthWell in support of your grant application. This not only applies to individuals, but it applies to providers as well.
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 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, HealthWell 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 directly 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 upon the fund in which you are enrolled, you may also receive a HealthWell pharmacy card . If so, please see the next question.
Are approvals retroactive to a certain date?
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 pre-approval.
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 front 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.
I get my prescriptions filled using my mail order pharmacy. Can I use my HealthWell Pharmacy card for my mail order prescription copayment?
Yes, if your insurer or prescription plan offers a mail order or specialty pharmacy benefit, you can use your HealthWell pharmacy card for the copayment. Simply call your mail order benefit and provide the HealthWell card number, BIN number . . . Be sure to explain to use this card AFTER using your primary, secondary insurers first.
Do I have to go to the retail pharmacy? Copayments for my prescriptions in the pharmacy are so expensive. Are there any other options?
You should ask your insurer if you have a mail order or specialty pharmacy benefit with your prescription plan. Mail order may be cheaper because you receive a greater supply of medication with the same, or slightly higher copayment. For example, instead of a 30-day supply at the pharmacy, you can get up to a 90-day supply, with your doctor’s approval, using mail order. And depending on your plan, you may pay the same copayment, or a slightly higher copayment for that larger amount than for three smaller fills at a retail pharmacy.
Drug X (Name Brand)
Drug X (Name Brand)
1st 30-day supply, copayment $250
90-day supply, copayment $500
Refill #1: 30-day supply, copayment $250
Refill #2: 30-day supply, copayment $250
TOTAL SPENT $750
TOTAL SPENT $500
How do I get information on my grant?
You can check on your grant any time online. Log on to our website and then select MY HEALTH-MY GRANT™, our real-time patient portal, or use 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
Can I speak with someone at HealthWell if I need to?
The HealthWell Foundation customer service phone lines are open from 9:00 a.m. to 5:00 p.m. Eastern Time, Monday through Friday. 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 website any time day or night at your convenience.
Can I reapply for assistance every year?
Yes. All active grant recipients are welcome to re-enroll in December as long as assistance is still required and the individual still meets the program criteria and funding is available.