Lyme-TAP Eligibility Requirements

The Lyme Test Access Program (Lyme-TAP) is a nationwide (USA) patient assistance program offered by Rotary Club of Southwest Eureka Foundation 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 up to 75% of the published list price for testing from a qualified CLIA/Medicare approved laboratory of your choice. 3rd-party charges for lab tests may vary from the actual list price charged by the labs. 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 patients not truly in financial need or insurance deductibles. Please allow several weeks for processing your application. We are not responsible for delays.

1. Eligibility requirements

  • Applicant must demonstrate true financial need, based on income, dependents and other circumstances.
  • Applicants must submit pages 1 & 2 and schedule 1 of their 2018 1040 Federal tax return, or page 1 of 2017 1040. If you are a dependent on someone else’s tax return, send their tax return as well. We do require your SS# for processing, so do not black it out. Please see Lyme-TAP Tips if you do not file a tax return.
  • Patient must submit laboratory testing receipt(s), not test results. Laboratory testing receipts older than 12 months are not eligible for grant reimbursements.
  • We are a nationwide program in the United States only and can only fund grants to recipients within the U.S.

2. Eligible Lab tests must be:

  • Initial diagnostic testing for Lyme Disease, other tick-borne diseases, or CD57 from any CLIA/Medicare-approved laboratory. Other tick-borne diseases are listed at Columbia-Lyme.org. Viruses, other lab tests, and doctor fees are not eligible.
  • Medically necessary.
  • Not covered by insurance. If coverage for laboratory testing is denied by your 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, completed and signed by their physician. Prepayments to the lab may take longer to process than reimbursements and may not be possible with all laboratories. It is recommended that you do your blood draw AFTER receiving your grant from Lyme-TAP. Prepayment checks will be made payable to the laboratory.  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. The amounts below represent your Total Income per your tax return, plus any nontaxable Social Security benefits shown.

 

Family Size

 

1 2 3 4 5 6 7 8
75% Grant $30,350 $41,150 $51,950 $62,750 $73,550 $84,350 $95,150 $105,950

Note 1

50% Grant $37,950 $51,450 $64,950 $78,450 $91,950 $105,450 $118,950 $132,450

Note 2

25% Grant $45,525 $61,725 $77,925 $94,125 $110,325 $126,525 $142,725 $158,925

Note 3

Note 1:  + $10,800 for each additional family member

Note 2: + $13,500 for each additional family member

Note 3: + $16,200 for each additional family member

Disclaimer. The Lyme Test Access Program is a grant program offered by Rotary Club of Southwest Eureka Foundation to assist applicants who have financial hardship by reimbursing a percentage of Lyme-related lab tests performed by any CLIA/Medicare approved lab that are 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 Foundation does 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 Foundation shall be final and subject to their sole and absolute discretion.