Apply For Assistance With The Cost of Your Cancer Treatment
The Cancer Care Network Foundation raises funds to provide financial assistance to patients with an active cancer diagnosis. Our financial assistance grants help patients with co-pays and deductibles required for commencement or completion of cancer therapy.
At this time, we do not provide cash assistance for non-treatment related needs.
If you or someone you know is in need of financial assistance for cancer therapy, please complete and submit the forms below (both patient and healthcare provider), or you may print and mail in a hard copy application* (you do not need to do both). Scan and email, or mail in your remaining documentation as outlined in the application.
Cancer Care Network Foundation
Attn: Financial Aid
PO BOX 881416, Los Angeles, CA 90009-7416
And/or Email to:
Fulfillment time of grant requests vary and can take anywhere from 30-90 days from the time of submission. No requests can be granted without a completed application and all required documentation from your provider and insurance company.
Required Documentation: Please submit the following information with your application via mail or email.
Diagnosis (MD Summary Note) and MD Signature.
Explanation of Benefits (EOB) Form from your Insurance Company
Bill/Invoice for co-pay or deductible due to your provider.
Income verification for all sources of household income. This may include;
Copy of your most recent 2 years federal tax returns. If you are required to file, or if you are claimed as a dependent a copy must be included with your application.
Bank statements (2 months)
Copies of both the front and back of your medical and prescription drug insurance card(s).
Current credit report (free credit reports are available online).
Valid California ID (i.e. driver’s license, etc.).
Two most recent payroll stubs.
***If you are not: required to file a federal tax return Or if your household income has changed significantly since you last filed a federal tax return, please call the Cancer Care Network Foundation (818-800-5806) to determine what information you should submit to verify household income.***