Patient Assistance Program

    

Assistance Program Purpose and Mission:
The Assistance Program is made available to provide emergency direct financial support for men and women currently diagnosed with breast cancer patients in current treatment. (Chemo, radiation, surgery or awaiting surgery with emergent needs to cover costs that have caused stress due to the fight against breast cancer.)

The program gives financial support to patients in states in which the Pink Ribbon Riders fundraise in through their volunteers and donor support. The funds stay in the states in which we fundraise in. The mission and the program was created to help those in need by people helping people right in their own communities.

Our hopes are to make the days less stressful by helping with expenses faced during that time.

 

Availability to apply, you must meet all 3:

 #1  - Applicant must reside in one of the following states listed below to be considered for assistance. 

  • Michigan
  •  North Dakota
  • Wisconsin
  •  Minnesota
  •  Colorado
  •  New York (currently not accepting patients from the NYC or Long Island area)
  •  Wyoming
 

 

#2  - Be  a US Citizen.

#3  - You must be in “Current” treatment for breast cancer receiving : Chemo, radiation, surgery  or awaiting surgery.

****  If you have applied to our program once before and received help from us already, before your reapply, please see the right side of this webpage as 2nd time giving is not always available.

 

 

The Gift of financial assistance:  

The gift of assistance is made available for both men and women in current treatments for the diganosis of breast cancer.
Each applicant may apply once in a lifetime.  Please see all requirements listed on this page to see if you qualify before applying.

The gift is given in the amount of $500.00 per year. (funds permitting).

*The committee reserves the right to distribute assistance amounts based on funds available at the time. Just because you apply does not mean you will be accepted. You must meet all the  requirements and proof of eligibility and PRR determines how much funding is given each month.

Your gift can take up to 5-6 weeks to be processed as we are very small at PRR and receive many requests each day and each week from the 7states in which we help. 

Summary of the Program:
- Assistance is made available to both men and women diagnosed with breast cancer that are in IMMEDIATE NEED of financial help through the Pink Ribbon Riders Patient Assistance Program.
- You must be currently undergoing breast cancer treatments (chemo, radiation, surgery) or awaiting surgery to apply.

-The program is designed for when you are just diagnosed and have lots of costs due to your diagnosis.
- The Assistance Program is a volunteer driven program that oversees applications submitted to Pink Ribbon Riders.

-The program is available due to the generosity of our donors and the volunteers that help with our fundraising events.

Requirements for Assistance:

  1. Applicant must be a U.S. citizen
  2. You must live in one of the states listed under “Availability”
  3. Part 1 and 2 of the application must be completed in full, including submitting all required documents.
    *Original signatures, No faxes or copies of doctor signatures will be accepted.

REQUIRED ATTACHMENTS that you send in with Part 2:   You MUST provide a copy of the following items:

  1. Proof of US Citizenship. Copy of Birth Certificate or Passport, or US Naturalization certificate.
  2. Copy of valid Drivers License or State Identification Card. 
  3. A copy of YOUR current income tax return – Page 1 showing proof of your income.
    * If you are not working: 
    * If you are only receiving social security – you must attach proof of your social security amount.
    * If you are only receiving unemployment or medical disability – you must attach proof.
  4. Copy of a medical bill related to your breast cancer treatment.

     - If you do not get because you are covered by insurance, please provide something that shows why you are in financial need.

example:    Utility bills  that are passed due.

Rent or mortgage bills that are past due.

Please… help us show WHY  you need the gift form Pink Ribbon Riders. 

5. A Doctor letterhead signed by treating doctor advising you are currently in treatment for breast cancer.

  • Must be an original signature by the doctor, not a copy or fax copy or a prescription pad or medical records. 
  • Must have your diagnosis date on it. 
  • Must have what treatment you are receiving (chem, radiation, surgery  or awaiting surgery  & the date of surgery) 

* Please send the 5 items all together. Please do not send separately or some from your doctors office and some from you.

 

When Will I Receive My Assistance?

If you are approved for financial assistance:

From the time we receive your Part 2 of the application in the mail, it will take us up to  5 to 6  weeks to process.

(Remember when you drop your application into the mailbox, it can take up to  another 5 + business days to get to us. Please allow for this time.

The giving of the financial assistance gift is  sent out the last day of the month.

*  If you have been accepted you will receive an email notifying you that you have been accepted about 4-5 days before the end of the month.

* If you apply to us in the mid part of the month or later, again it will take up to 5 or so weeks for us to process, so  you would not get assistance till the following month.

More  questions?   Click here to see FREQUENTLY ASKED QUESTIONS and ANSWERS.

 

Important Facts:

  • You must be a US Citizen. Please do not apply if you can not prove that you are a US Citizen.
  • Your application will NOT be processed or considered without the above  5 requirements.
  • On occasion testimonials may be required by applicant at the approval committee’s request.
  • Policies and application criteria are reviewed periodically and amended accordingly.
  • We can’t accept applications from other organizations. You must submit the Pink Ribbon Riders application.
  • We can not process applications completed in a foreign language.
  • We will contact you if we have questions about your application. Please do not call or write us regarding your application.

 

TO APPLY:
There are 2 Parts in the Application Process: You must be the patient to apply please.

  1. Part 1 – Online Form    -  Sorry we do not mail Part 1. You must apply online. Please do not contact us to mail it to you. 
  2. Part 2 – A downloadable form. - You will be provided the link upon completing part 1.   DO NOT reproduce part 2 for others, changes might have been made.3
  3. .Provide the 5 required documents listed above with your completed Part 2 and mail.

You will be prompted after completing Part 1 to access Part 2.

+ There are 2 ways to access Part 2:
+ After clicking SUBMIT on Part 1, you will be given the link to Part 2. Copy/Paste the link into a browser window.
+ AND You will also receive an email with a click able link to Part 2, and can also access Part 2 this way.

Mail Part 2 and all required paperwork to submit your application:
Pink Ribbon Riders
Attn: Assistance Fund
5420 Beckley Road, Suite 334
Battle Creek, Michigan 49015

SOCIAL WORKERS/ NURSES/ CAREGIVERS/ FRIENDS  -  PLEASE   PRINT THIS GUIDE TO HELP YOU or GIVE TO SOMEONE YOU KNOW THAT  : CLICK HERE

 

                                                     STOP!  

PLEASE DO NOT APPLY IF YOU ARE NOT A RESIDENT OF THE UNITED STATES OR  DO NOT LIVE IN ONE  OF THE FOLLOWING STATES:  New York, Michigan, Minnesota, Wisconsin, North Dakota, Colorado or Wyoming.

                                                                   Thank you!


Policy:
The policy is to guide the organization and its volunteers in processing requests from breast cancer applicants who have completed the application for assistance with Pink Ribbon Riders.

  1. The Assistance Program has the right to have “open and closed” periods. If there is a period where the program is closed, notification will be done on this page of the website. * The website will serve as the official notice for the Patient Assistance Program.
  2. The Assistance program is closed to new applicants during the last week of each month so we can process existing applications.
  3. Each applicant may apply once a year, up to two years total. The gift is given in the amount of $500.00 per year. (funds permitting). *The committee reserves the right to distribute assistance amounts based on funds available at the time.

Disclosures:
- The Pink Ribbon Riders do have the right at anytime to make changes to the application process should there be a need from the Pink Ribbon Riders organization.
- If you are a doctors office or social worker with questions about our program, please contact us first before having patients apply.

As a very small organization we would love to talk with you first.
- Pink Ribbon Riders is compliant with all HIPAA patient privacy requirements.

In order for the Pink Ribbon Riders to best help as many men and women diagnosed with breast cancer as possible the following items will be limited/capped.
- Lifetime financial assistance will not exceed $1,000.
- Once a year assistance is capped at $500.00. * It is on the anniversary date of your first gift received. If the program is open to 2nd time applicants.

The Pink Ribbon Riders is a small volunteer based organization. To date over 1,200+ people diagnosed with breast cancer have been helped by the Pink Ribbon Riders.

 

 UPDATE AS OF : 

4/1/2014 - We are not accepting 2nd time applicants.  

 

For a list of additional organizations who may be able to provide assistance: CLICK HERE

For assistance in Canada please see the Kelly Shires Foundation