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Copay Accumulators and Copay Maximizers
Are you experiencing your insurance policy not allowing copay assistance to be counted toward your deductible or out of pocket maximum? Please fill out the survey below to provide more details about your current situation. Thank you.
1.
Please provide your contact information so we can follow up with you should we have any questions.
Name
Address
Address 2
City/Town
State/Province
ZIP/Postal Code
Country
Email Address
Phone Number
*
2.
Who is your insurance provider?
(Required.)
*
3.
Do you have a self-funded insurance plan, state/marketplace plan, other, or not sure?
(Required.)
Self-Funded Plan (ERISA)
State Plan (Marketplace/Pennie)
Other (Medicaid, Medicare, Tri-Care)
I'm Unsure
4.
Please use the space provided below to explain your current situation. The more details you can provide, the better. If we have additional questions, a member of the Bleeding Disorders Foundation will contact you. Thank you.
