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Patient Emergency Financial Assistance

Guidelines

  1. Program is for dialysis or kidney transplant patients. Patients must reside or receive treatment in Indiana.   
  2. An emergency is defined as an acute situation which can be alleviated or resolved by assistance that is not on-going.  
  3. Patients should not be directed to call the NKFI about receiving assistance.  We depend on the social workers to know the situation and make the request.
  4.  If the social worker is unsure about the appropriateness of the request, please call the NKFI office prior to sending the request.
  5.  Requests must be processed and submitted by the patient’s renal health care provider (i.e. social worker, physician, transplant coordinator, etc.) using the NKFI emergency assistance request form.
  6. Documentation (e.g. bill or invoice) of the requested amount must be attached to the application form before payment can be made. 
  7. The NKFI Emergency Financial Assistance Program is a payer of last resort. Other available financial resources should be researched and documented on the request form.  Other resources could include the American Kidney Fund, patient family, local church/social service organizations, trustees office, utility company, etc.
  8. The amount of financial assistance per patient per 12 month period (January-December) can be limited depending upon previous requests and funding that is available.
  9. Services eligible for assistance include: food, medications, medical supplies, medical equipment not covered by insurance, utilities (in most cases an amount needed to avoid disconnect will be awarded), medical transportation, and housing.
  10. Payments are not made to the patient. Checks are sent directly to the provider of the goods or services, or in some instances (e.g. grocery card purchase) sent to the social worker.
  11. The NKFI has the right to deny any request.
DOWNLOAD THE APPLICATION

How to Apply

  1. Download and complete the application.  
  2. Email or fax the application and supporting documentation to: nkfi@kidneyindiana.org / 317.722.5650 Attn Emergency Fund
  3. An NKFI staff member will review your application and contact you with any questions. 
  4. You will be notified via phone or email if your request is denied. If your request is approved, you will receive a confirmation letter in the mail.