Application for Individual Financial Assistance

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Criteria for Consideration of Financial Assistance

  • Applicant must be under active treatment for head and neck cancer or has undergone treatment for head and neck cancer by an established oncologist.
  • Applicant must complete and submit this HNC Living Foundation Individual Application for Assistance.
  • Applicant must meet income qualifications.

Not Covered:

  • Expenses not related to head and neck cancer treatment or recovery
  • Expenses that can be paid for through other community resources (i.e., emergency assistance funds for rent or utilities, food pantries)
  • Expenses that are covered by private insurance, Medicare or Medicaid
  • Debt reduction, past due medical/dental bills, or costs incurred BEFORE application submission date
  • Home modifications

HNC Living Foundation Can Assist Patients Diagnosed With the Following Types of Head and Neck Cancer:

  • Oral Cancers
  • Salivary Gland Cancer
  • Throat Cancer
  • Upper Esophageal Cancer
  • Nasal & Sinus Cancer
  • Thyroid Cancer
  • Laryngeal Cancer

Eligible Covered Expenses after Approval May Include but Are Not Limited To:

  • Co-pays and deductibles for appointments and treatments
  • Dental care (pre-treatment and post-treatment)
  • Travel costs, including gas cards, for appointments related to treatment
  • Nutritional supplements
  • Doctor ordered and approved medical supplies and equipment not covered by insurance
  • Medication and prescriptions related to head and neck, trained and board-certified medical oncologist
  • Oral nutritional supplements and enteral nutrition (tube feeding) during treatment

Review of Applications and Payment of Grants

  • Requests of less than $1,500 will be reviewed and financial aid determined within 10 business days
  • of receipt of completed application and supporting documents. Requests of more than $1,500 will be reviewed by HNC Living Foundation’s Grant Committee and financial aid determined within 30 days.
  • Payment will be made directly to service providers or vendors for future services.
  • No cash payments will go directly to the patient.