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.
Tips – General
We are a small, all volunteer organization. To help keep the workload down and expedite application processing, please carefully complete all parts of the application. Our staff communicates primarily via email. Failure to provide an email address may delay processing of your application.
- Send an email after submitting an application to be sure it was received to lymetap@gmail.com
- Be sure your application is completely filled out. Do not write “see receipt”. List the lab tests you are requesting on the application form with the individual test costs.
- Be sure to submit the entire 3 parts of the application package.
(1) The completed application (with signatures) Download Application Here
(2) The income verification (Pages 1 and 2 and Schedule 1 of most recent 1040 Federal tax return). 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.
(3) For Reimbursement: Your laboratory test receipt(s). For prepayments to the lab: Your laboratory test requisition that has been completed and signed by your doctor. Please submit receipts or lab requisitions for lyme-related tests only. Lyme-TAP does not offer grants for testing for viruses, other general lab tests, or doctor fees. Please do not send test results.*Note: Please do not submit other unrequested information such as test results, doctor bills, or additional tax return pages.
- Submit the required pages of your tax return, not a summary. Please do not submit additional pages. If your tax return has been amended, please submit your original tax return pages 1 and 2 and Schedule 1 of most recent 1040 Federal tax return.
- Be sure the physician who ordered your laboratory tests fully completes their portion of the application.
- If you have questions, please be sure you have read the eligibility requirements page of the application first. If this information does not answer your question, then contact the program via email or fax.
Tips For Completing Your Application
Part A)
Your Information
Grant checks are mailed out to the address listed here.
Healthcare Provider Information
This part is for listing the healthcare provider’s information (not insurance information).
Child information
If this grant application is for a child, please put their name & age here.
Diagnostic Test Information
List the lab tests to be performed and their cost individually. Do not write “see receipt”.
Part B)
Statement of Financial Need
Please be sure all applicable boxes are completed and that the application is signed. For the question of “have you been tested previously”, see below “Tested Previously” under commonly asked questions and answers.
Part C)
Healthcare Provider’s Certification
Please be sure your healthcare provider has completed this part and signed the application.
COMMONLY ASKED QUESTIONS AND ANSWERS
What kinds of tests are covered?
Q What kinds of tests are considered for grants?
A The program covers laboratory testing for Lyme disease, other tick-borne diseases and the CD-57. We refer to Columbia University’s Lyme and Tick-borne Disease Research Center for a list of other tick-borne diseases at Columbia-Lyme.org.
Fund Depletion
Q I saw a notice on the website that program funds are depleted and applications are not being accepted. When will you reopen the program and accept applications?
A From time to time, the program funds become depleted due to the popularity of the program. We post a note on the website and have an auto-reply from our email as to the status of funds. Keep checking the website for updated information.
Laboratories
Q What laboratories can I use?
A You can use any CLIA/Medicare approved laboratory, most USA laboratories are. If you don’t know if the lab you are choosing is CLIA/Medicare approved, you can call them or look at their website.
Tested Previously
Q I have been tested in the past but the testing was a long time ago and my doctor says I need to be retested (or the test was inconclusive). What can I do?
A The program is intended to fund grants for initial diagnosis and does not cover duplicate testing. Write a note as to why you are being tested again on your application or attach a letter and we will take your case into consideration.
Second Grants
Q I previously received a grant for Lyme disease testing, can I apply for another grant for co-infection testing?
A Yes, applicants can reapply provided the testing is not duplicative. Grants are to be for initial diagnostic laboratory testing for Lyme disease, other tick-borne diseases and the CD-57. Please be sure all applicable boxes are completed and that the application is signed. For the question of “have you been tested previously”, see below “Tested Previously” under commonly asked questions and answers.
What tests should my doctor order?
Q What testing should my doctor order?
A The testing that your healthcare provider orders is between you and your healthcare provider. If your healthcare provider needs information on testing, they typically can call the chosen laboratory for more information.
Tax Return – Income Verification
Q I am on Disability, Medicaid or Food Stamps and have not filed taxes. What can I do?
A You can submit your most recent SSI/SSDI statement, or Medicaid or Food Stamps approval letter, with a written explanation.
Q I am now on unemployment and my income is reduced from what is shown in my tax return. What do I do?
A You can submit a copy of your unemployment statement and send in a note with your application to explain your current financial situation.
Income Guidelines
Q I am over your income guidelines but have extenuating circumstances. What can I do?
A You can submit a letter explaining your circumstances and providing what you believe will substantiate your financial need. We will take your case into consideration.
Insurance
Q I have health insurance but it will not cover out of network testing.
A You can have health insurance and still qualify for the program if your insurance company will not cover the laboratory testing in question. The program is not intended to cover deductibles or co-pays. 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.
Reimbursements
Q I have paid for my testing and am asking for a reimbursement. What kind of receipt do I need to submit?
A The receipt for laboratory testing must be from the performing laboratory, include a list of the lab tests performed, the cost and show receipt of payment. The receipt must include the names of the tests, not just the codes. Please do not submit test results.
Prepayments
Q How does the prepayment option work?
A We prefer to issue reimbursements for grants. However, in the event that this is not possible, you can request a prepayment to the laboratory. To receive a prepayment to the laboratory, instead of submitting a receipt, you submit a copy of your laboratory requisition form that has been completed and signed by your medical professional, and has been signed by you as well. This is the doctor’s order to the lab that shows what tests are to be performed. Include the cost of each individual test. The list of lab tests must include the names of the tests, not just the codes. Note: Grant checks for prepayments are made payable to the laboratory and mailed to the grant recipient to the address listed on the application. Prepayments may take longer to process than reimbursements. We are not responsible for delays.
Grant Checks
If approved, you may be reimbursed for up to 75% of the list price that the labs publish for testing from a qualified CLIA/Medicare approved laboratory of your choice. Most of the laboratories publish the price of their lab tests on their websites. Third-party charges for lab tests may vary from the actual list price charged by the labs.
Phone Calls
Q How can I speak with someone on the phone?
A The program does not have a phone line. We can be contacted via email, fax or regular mail. Email is the best way to communicate with program volunteers.
International Inquiries
Q Do you give grants to residents of other countries?
A Currently, we are a nationwide program in the United States only and can only fund grants to recipients within the U.S.
Other support
Q Where can I find other support?
A The Lyme-TAP program is limited to providing grants for laboratory testing for Lyme and other tick-borne diseases. We do not provide grants for viruses or other lab tests. In addition, we do not recommend specific laboratories, provide doctor referrals or provide medical advice. Please see our disclaimer. See below for other organizations that may be able to provide assistance.
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