|
Policies |
|
|
|
MY FRIENDS CARE BMT FUND POLICIES AND PROCEDURES FOR A BONE MARROW/STEM CELL TRANSPLANT PATIENT
SECTION I – BECOMING A MFC PATIENT INITIAL REQUIREMENTS When a transplant patient or his/her family initially approaches MY FRIENDS CARE BMT FUND for assistance, verification of the patient’s medical status and insurance status must be made. REQUIREMENTS WHICH MUST BE MET TO BECOME A MFC PATIENT An individual becomes a MFC patient when MFC receives: (1) the completed MFC Patient/Group questionnaire and Patient Agreement which has been signed, indicating that the patient or his/her guardian has read the MFC Policies and Procedures and agrees to abide by them; (2) verification and determination of the patient’s insurance status; and (3) a letter from the patient’s physician verifying the need for a bone marrow/stem cell transplant. (4) the family support group (5-15 people) attend an orientation meeting with the MFC representative. At this point your group is officially affiliated with My Friends Care BMT Fund and able to begin fund raising. SECTION II – SUPPORT SERVICES FUND RAISING ASSISTANCE MFC assists transplant patients in raising funds through organized grass roots fund-raising campaigns in the patient’s community. Successful campaigns require the active involvement of the transplant patient’s family, friends and community volunteers. Each transplant patient and/or family is required to provide a list of volunteers who will be willing to work on a committee to help raise funds for the patient’s transplant and related expenses. When this core group of volunteers ( five to fifteen people) is identified , a MFC representative will help organize a MFC Support Group for the patient. MFC will initially meet with and guide support group volunteers to best utilize the resources in their community and provide them with fund-raising expertise, fund-raising products and support materials. A partnership will be formed between the support group volunteers and MFC staff to strengthen the campaign’s fund-raising efforts, and to raise the required funds for the transplant patient as quickly as possible. PATIENT ADVOCACY If the MFC patient doesn’t have sufficient funds in his/her account to pay his/her transplant-related bills and the patient and/or fund-raising group is continuing to actively raise funds, MFC will make every effort, on the patient’s behalf, to negotiate satisfactory payment arrangements with the billing source. Often, MFC can help patients avoid having their transplant and associated medical bills turned over to a collection agency. SECTION III – COLLECTION & DISBURSEMENT OF FUNDS RAISED ON BEHALF OF THE MFC PATIENT PATIENT DONATIONS Donations are made payable to My Friends Care BMT Fund and can only be used to pay for the transplant and related expenses as outlined in these policies and procedures; Section III. Donations are posted to the appropriate patient’s ledger and deposited into the MFC general bank account. A monthly statement is sent to the Support Group Treasurer verifying contributions and/or disbursements. One hundred per cent of funds raised are designated for the patient’s transplant-related expenses. Interest and investment earnings from all MFC funds will be retained by MFC for the administration of MFC office. Any bank charges MFC realizes from credit card donations or payments are deducted from the respective patient account. TRANSPLANT-RELATED EXPENSE POLICIES ACCOUNTABILITY: MFC is accountable to the federal government, state government and the public for funds raised for its transplant patients. As a guardian of the public trust, it is MFC responsibility to ensure that funds raised for its patients’ transplant and related expenses are collected, disbursed and used properly and responsibly. Accordingly, MFC has adopted these policies and procedures to best assure proper accountability for the funds that are raised on behalf of MFC patients. PAYMENT OF TRANSPLANT-RELATED BILLS/EXPENSES: To relieve the financial burden on the MFC patient and his/her family, MFC prefers to make payments directly to hospitals, physicians and other providers of transplant-related care. Accordingly, once the patient has received an itemized bill for transplant-related care or service and verified that the charges that are billed are accurate, the patient should then forward the bill to his/her support group treasurer. The bill is then sent to MFC to be approved and paid directly to the billing source. The itemized bill must state the patient’s name, date(s) of service provided, and a description of the service or care that has been provided. Under specific conditions, reimbursement for transplant-related payments may be made to the patient/guardian with proper documentation and approval. A record of each transplant-related payment must be received by MFC in order to reimburse the patient. All MFC patients are provided with MFC Expense Forms to keep itemized records of their “out-of-pocket” transplant-related payments. When a patient requests reimbursement for an “out-of-pocket” transplant-related payment, the appropriate MFC Expense Form, along with original receipts or other verification that a payment has been made, must be sent to MFC via the support group Treasurer, to initiate reimbursement. These records are required in order for MFC to meet IRS regulations and substantiate each disbursement for its annual audit. To the extent that there are sufficient funds in the respective MFC patient’s account for MFC to issue payments to providers of care and services, or for reimbursement of “out of pocket” expenses, as authorized and substantiated per the provisions stated above, MFC will issue payment within fifteen business days of receipt. Generally all payments will be posted and mailed out utilizing the U.S. Postal Service. On the rare occasion where the situation dictates that payment of a deposit or bill must be expedited, MFC will attempt to accommodate the situation. Those submitting the necessary forms and documentation for reimbursement must allow for: the time required for the U.S. Postal Service to deliver the reimbursement request to MFC, the time of up to fifteen business days allowed for MFC to review and process the request, and the time required for the U.S. Postal Service to return the payment. Those requesting reimbursement for authorized expenses who may have concerns in regards to their personal cash-flow situation are encouraged to submit all requests for reimbursement as soon as possible after the allowable “out of pocket” expense has been realized. This approach should eliminate or minimize most adverse cash-flow situations which might occur. PRIORITIZATION OF PAYMENTS: Payment of a patient’s transplant-related bills negotiated by MFC or other financial arrangements/assurances made by MFC with the transplant centers will receive top priority for payment over other transplant-related bills incurred by the patient. An example of this would be a deposit required by the transplant center to be listed to start a donor search for an unrelated bone marrow/stem cell transplant. The payment of current and outstanding charges for transplant-related expenses and treating the underlying disease will be treated as the second priority for payment from the funds raised. To the extent that sufficient funds are raised in excess of those required to meet transplant center deposits and other current and/or outstanding qualified charges, funds in the account may be utilized by the patient to recoup expenses that were paid by the patient for up to six months before the patient signed with MFC so long as the expense would have been covered if the agreement had been in effect earlier and proper documentation of the payments, such as receipts, are provided. POLICIES ON USE OF FUNDS RAISED FOR THE MFC PATIENT: “Usual” transplant and related expenses which may be paid from funds raised: It has been the experience of MFC that there are several transplant and related expenses that have been found to be “usual” expenses that most transplant patients will encounter and which are seldom questioned. Also, it is not required to secure prior MFC approval, unless the patient is uncertain if an item would fall within this category of “usual” expenses. However, based on the facts and circumstances of each patient, approval & verification may still be required from the patient’s physician stating an expense was related to the transplant or to the underlying disease that has brought about the medical need for a transplant. The specific guidelines for payment of each transplant expense in this category are listed as follows: MEDICALLY RELATED EXPENSES: Transplant evaluation, donor search, testing, procurement, transplant surgery, physician fees and pre/post transplant care charges are standard approved expenses. In addition, it is common for transplant patients to undergo preventive dental treatment in advance of the transplant, which, if prescribed by the patient’s physician, is a covered expense. Also, to the extent funds are available, and with proper verification by the patient’s physician, funds may be used to pay any outstanding or forthcoming medical expenses for treatment of the underlying disease/condition which necessitated the transplant. Further, available funds may be used to treat medical or dental conditions that result from the transplant or the associated treatment, such as treating the negative side affects of prescribed drugs for the patient who develops an adverse reaction. MEDICATIONS: Medications prescribed by a physician for transplant-related treatment and care are standard approved expenses. COUNSELING SERVICES: The charges for psychiatric or psychological counseling services not covered by medical insurance for the patient or other immediate family members may be paid from the funds raised if the patient’s attending physician determines that the need for such services is related to the patient’s medical condition or the added stress and/or anxiety of not knowing if or when the transplant will take place and whether or not it will be successful. ASSISTED HOME-HEALTH CARE: Assisted home-health care may be paid from the MFC patient’s account if a patient does not have a spouse, parent or other family member that can stay with the patient during stays in another community while undergoing the transplant and immediate post –transplant follow-up care, when the presence of such support is prescribed by the patient’s physician. Assisted home-health care may also be paid if a patient’s condition following transplant and return to his/her home dictates that assisted home-health care is warranted and has been prescribed by the patient’s physician. Such physician approval must specify the length of time that such care will be required based on the medical condition of the patient. Family members (including the patient’s spouse, parents, grandparents and siblings) may not be paid by MFC for assisted home-health care. CHILDCARE SERVICES: Childcare services for siblings and/or the transplant child is sometimes a required necessity during the transplant process. Adult transplant patients who have children may also find it necessary to obtain childcare services. These services may be paid from the MFC patient’s account during the transplant surgery/hospitalization, and during the periods when the patient remains under active observation and care immediately following the transplant. It may also apply when the member of the household who may have parental responsibility for the child is otherwise occupied as the primary caregiver for the transplant patient. Family members (including the patient’s parents, spouse, grandparents and siblings) may not be paid by MFC for providing childcare services. HEALTH INSURANCE: Because many transplant patients cannot afford the costly health insurance premiums which cover transplant-related expenses and medications, funds which have been raised may be used to pay the premiums, co-payments and deductibles for the transplant patient alone. LONG-DISTANCE TELEPHONE CALLS: When the patient’s hospital and/or physician is located in another city of state, all long-distance phone calls from the patient to his/her physician and/or transplant hospital may be paid from the MFC patient’s account. When a patient’s condition requires stays at hospitals and/or hotels for transplant-related medical treatment away from their residence, long-distance phone calls to or from an immediate family member may be paid from the MFC patient’s account, normally on a limited basis of one completed long-distance phone call per day. In the cases of a dramatic change in the health status of the patient, or during the period of time between being called in for transplant and the next few days of post transplant care, additional long distance phone calls may be paid for from the MFC patient’s account. MEALS/GROCERIES: When it is necessary for a transplant patient to travel away from home to receive treatment for pre/post transplant care, meals for the transplant patient and caregiver may be paid from the MFC patient’s account. Meals for two caregivers may be paid if the patient is a child. Meals should be reasonable and should not be lavish or extravagant. Often a transplant patient’s physician requires that he/she move to another city or state for a short period of time. When this occurs, meals and/or groceries may be bought from the MFC patient’s account for the patient and caregiver (s). Groceries should also be reasonable and should not be lavish or extravagant. The patient and caregiver(s) are reminded that itemized receipts must be submitted in order to receive reimbursement and in the case of restaurant purchases a copy of the credit card receipt will not suffice. Meals/groceries will be reimbursed with proper documentation up to $200.00 per week, per family. The patient and caregiver(s) must also note that MFC does not reimburse the patient or caregiver(s) for the purchase of alcoholic beverages or tobacco products at any time. In these cases the “caregiver” is defined as a family member who is not being compensated for providing his/her presence and assistance. Food and meals are not provided for assisted home-health care employees because they are being compensated for time spent with the patient. TRANSPORTATION: (Transportation to/from the hospital, physician’s office and/or other provider of health care) Transportation expenses may be paid from the MFC patient’s account when travel is required away from home for the primary purpose of obtaining transplant and/or related health care for the patient. Travel expenses for the transplant patient and a caregiver (up to two caregivers if the patient is a child) may be paid. Transportation expenses include personal automobile gas receipts, parking fees, road tolls, car rental (when necessary and more cost effective), taxi and/or coach class airfare on a commercial carrier. LODGING IN A COMMERCIAL FACILITY: Lodging may be paid from the MFC patient’s account when lodging is required away from home for the primary purpose of obtaining the transplant and/or related care and in a commercial facility (e.g. hotel, motel, apartment.) Please note that MFC cannot pay family members or friends of the patient for lodging provided in their private residence. In the case of an extended stay, MFC may be called to assist in securing lodging for the transplant patient and caregiver in order to arrange the direct billing of the appropriate lodging charges. When the transplant patient makes lodging arrangements, the costs of the lodging should be reasonable and should not be lavish or extravagant. RECOUPING “OUT-OF-POCKET” PAYMENTS MADE PRIOR TO SIGNING ON AS A MFC PATIENT: Funds in the MFC patient’s account may be utilized by the patient to recoup expenses that were paid by the patient (or his/her parents if patient is a child) for a period of up to six months before the date the patient signed with MFC for a transplant-related expense covered under Section III of these policies and procedures if the agreement had been accepted by the patient earlier and proper documentation of the payments, such as receipts, are provided. Also, payments to recoup allowable transplant-related expenses will only be made to the extent that sufficient funds are raised in excess of those required to meet transplant center deposits and other current and/or outstanding qualified charges, as specified in Section III of these policies and procedures addressing the “Prioritization of Payments.” “EXTRAORDINARY” TRANSPLANT RELATED EXPENSES: which, with MFC approval, may be paid from funds raised: It has been the experience of MFC that each transplant patient presents a unique set of circumstances that may result in other “extraordinary” transplant-related expenses that legitimately may be paid from the funds raised on his/her behalf. Accordingly, the MFC patient and their fund-raising support group is encouraged to anticipate other “extraordinary” expenses and to raise the additional funds to help cover these expenses. As each patient’s circumstances may be unique, it is required that the patient and/or his/her caregiver request in writing the approval of the MFC Board of Directors, prior to making an obligation or payment for an “extraordinary” expense , for which reimbursement, or the submission of a bill for payment from the patient’s MFC account is submitted. Generally, MFC ‘s approval for payment of these “extraordinary” expenses will require verification from the patient’s physician or an associated healthcare professional that the anticipated “extraordinary” expense for service and/or care has been medically prescribed or recommended and is directly related to the transplant or the disease/condition which prompted the need for the transplant. MFC cannot anticipate every possible “extraordinary” transplant-related expense. Whenever there may be a question as to whether or not an anticipated expense will be paid from the funds raised, it is advisable to contact MFC to seek guidance and approval prior to incurring the expense, if reimbursement is expected. Specification on what the funds raised on behalf of a MFC patient MAY NOT be used for or expended on: Working within regulations and guidelines of the IRS and the general expectations of the individual and corporate contributors for a charitable cause and organization, MFC has determined that the funds which have been raised for the MFC patient’s transplant and related care cannot be used to offset loss of income or certain other specific expenses or to provide a new asset. Generally, expenses that a patient might normally expect to experience had he/she not been required to have a transplant cannot be covered. To remove any question as to the prohibited use of these funds, refer to the following: Funds contributed for the MFC patient’s transplant and related care MAY NOT be expended for The following: Loss of income (because of the patient’s medical condition) by the patient, his/her spouse (or parents if the patient is a child), a living donor, other family members and/or friends to help care for the patient. Payment of rent or the mortgage payment on principal residence. Payment of normal utility charges on the patient’s principal residence. Installment and/or repair payments for the patient’s car. Payment of any taxes due. Payment for any outstanding debts (credit cards or installment loans) which are unrelated to the transplant or the medical condition which necessitated the transplant. Payment for any remodeling or furnishings for the patient’s principal residence not prescribed by the patient’s physician and directly related to the transplant. Payment for routine meals and groceries consumed at the principal residence (an exception may be made for physician prescribed nutritional supplements.) Payment for any clothing normally worn by the patient. Payment for activities or items for the purpose of entertaining the patient and/or caregiver while at home, or in conjunction with transplant-related treatment in another community. This prohibition applies to such things as: amusement park, concert, movie or theater tickets, movie rentals, toys, games, books and magazines. Payment for house sitting the principal residence while the patient and caregiver may be out of town for transplant-related care and treatment. Payment for the care and boarding of pets or livestock. Payment for gifts or gratuities for hospital or healthcare providers. Payment of premiums of policies for life insurance, auto insurance, home owners or rental insurance, disability insurance, private property insurance, liability insurance and travel insurance. Payment of any fines, legal fees and/or expenses, or court costs assessed to the patient. LIFETIME COMMITMENT Funds collected for a MFC patient will remain in his/her MFC account for life (or until they are depleted) to pay approved transplant and related bills not covered first by medical insurance policies or governmental assistance (Medicare, Medicaid, similar governmental programs or successors to these programs.) An exception to this commitment may occur under the provisions of these policies and procedures specified in Section IV. In the event of a patient’s death, if the patient’s family does not have specific burial insurance coverage for funeral services, funds remaining (up to $4000.00) in the MFC patient’s account may be used for specified expenses of a funeral. The payment of any additional outstanding transplant and related bills from any funds that remain in his/her account will be at the discretion of MFC with the advice and counsel of the next of kin. Approximately one year after the death of a patient, any remaining funds (after all outstanding transplant and related bills have been satisfied ) will be transferred to the MFC general fund to benefit MFC programs benefiting the transplant community, as determined by the Board of Directors of MFC. FUNERAL SERVICE AND GRIEF COUNSELING EXPENSES: The following funeral service expenses are approved for payment by MFC up to $4000.00 · Embalming, preparation of the body, use of funeral home facilities, transfer of the remains, use of automotive equipment, police escort, acknowledgment cards, memorial folders and a book for mourners to record their attendance at the service. · Casket & spray of flowers. · Burial vault and/or plot. · Grave opening and closing. · Rental of tent & equipment for committal service , and · Purchase of a reasonable grave marker. OR · Crematorium expense. · Urn, and · Memorial service, including acknowledgment cards, memorial folders and a book for mourners to record their attendance at the service Grief Counseling: To the extent funds remain in the MFC patient’s account, and health insurance has been fully utilized, following their death, these funds may be used for grief counseling for the surviving spouse, his/her children, parents, and/or siblings for a specified period. MFC will authorize payment for grief counseling for up to a period of six months within a one-year period following the death of the patient. SECTION IV – ONGOING RESPONSIBILITY OF THE MFC PATIENT MAINTAINING CONTACT WITH MFC: Whenever a balance remains in the MFC patient’s account the MFC Support Group Treasurer and/or the MFC patient (parent/guardian if patient is a child) agrees to keep MFC informed as to any changes in the patient’s name, home address and/or home phone number and to notify MFC as to the date(s) of his/her transplant if not informed by a member of the patient’s family or support group at the time of transplant. TREATMENT OF REMAINING FUND BALANCE IF CONTACT BETWEEN MFC AND THE PATIENT IS SEVERED. The MFC patient understands that in the event that he/she fails to inform MFC of a change of name, address, and/or phone number and the best efforts of MFC to locate the MFC patient are unsuccessful over a period of one year, MFC may close the account and utilize the remaining balance according to MFC Policies and Procedures in force at that time. RESTORATION OF ACCOUNTS CLOSED UNDER SECTION IV The MFC patient understands that in the event that an account with a balance was closed under the provision of Section IV of these policies and procedures, that it is entirely within the discretion of the MFC Board of Directors whether an account balance will be restored from MFC assets. If the MFC Board of Directors restores an account and balance, the MFC patient understands that expenditures from that account may be made per the governing policies and procedures of MFC at that time. MFC Policies and Procedures effective as of January 1, 2001
POLICY AND PROCEDURE ADDENDUM (Passed by motion at the November 19, 2003 Board of Directors Meeting) RENT AND/OR MORTGAGE AND UTILITIES PAYMENTS AT PATIENT’S PRINCIPAL RESIDENCE Funds may be used on a short term basis to make rent/mortgage payments and/or utility payments at the patient’s principal residence, if the following criteria are met and there are funds available in the patient’s account:
Any situations in which the above criteria are not met must be submitted, in writing, to the My Friends Care Board of Directors for consideration. The Board of Directors decision is final.
Copyright 2000-2006. My Friends Care Bone Marrow Transplant Fund.
|
|