The Lyme Test Access Program (Lyme-TAP) is a nationwide patient assistance program offered by Ferndale Foundation in coordination with Rotary Club of Southwest Eureka to provide reimbursement assistance of initial Lyme-related lab tests to patients who demonstrate true financial need. To apply, send a completed application along with requested documentation to the fax number above. If approved, you may be reimbursed for up to 75% of your out-of-pocket costs of testing from a qualified CLIA/Medicare approved laboratory of your choice. Funds are limited & are available on a first-come, first-served basis. Children under 18 years of age are given priority. The intention of this program is to help as many patients in need as possible. It is not intended to cover insurance deductibles or to cover patients not truly in financial need.
1. Eligibility requirements
- Applicant must demonstrate true financial need, based on income, dependents and other circumstances.
- Patients must submit the first page of their 1040 Federal tax return.
- Patient must submit laboratory testing receipt(s), (not test results). (Laboratory testing receipts older than 18 months are not eligible for grant reimbursements).
2. Eligible Lab tests must be:
- Initial diagnostic Lyme disease testing, other tick-borne disease testing or CD 57 status
- Medically necessary
- Not covered by insurance
• If coverage for laboratory testing is denied by insurance company, submit a copy of
the Explanation of Benefits (EOB) from the insurance company showing the denial.
- Not duplicative of other tests
- From any CLIA/Medicare-approved laboratory
3. Patient’s physician must certify:
- Medical necessity of test(s)
- Lack of insurance coverage for test
- Patient’s financial need
Reimbursements to patients for lab tests will be made only after receipt of proof of payment for eligible testing. Payments of approved grants could take several weeks. Patients who cannot afford to pay for
testing may submit a lab requisition form with pricing, signed by their physician to Lyme-TAP. If possible, Lyme-TAP will pay the laboratory directly for up to 75% of the reasonable laboratory costs of covered testing. Other limitations may apply. Prepayments to the lab may take longer to process than reimbursements and may not be possible with all laboratories. We are not responsible for delays.
Income guidelines are based on the following levels. If you exceed the income guidelines but are in true financial hardship due to extenuating circumstances, please explain.
|Gross Annual Income||$27,075||$36,425||$45,775||$55,125||$64,475||$73,825||$83,175||$92,525|
Disclaimer. The Lyme Test Access Program is a grant program offered by Rotary Club of Southwest Eureka and Ferndale Foundation (FF) to assist applicants who have financial hardship by reimbursing a percentage of Lyme-related lab tests (performed by any CLIA/Medicare approved lab) that is deemed necessary by their healthcare provider. The program is not intended and should not be construed as giving medical advice or as endorsement of the necessity of or the reliability of any lab test ordered by your physician or of any treatment recommendations by your healthcare provider. Rotary Club of Southwest Eureka & FF do not warrant or endorse and specifically disclaim any liability for loss or costs incurred by patients related to the validity or results of any lab test, delays, or medical treatments. Any determination of eligibility for grants by Rotary Club of Southwest Eureka & FF shall be final and subject to their sole and absolute discretion.