Thank you.
Personal Info
Diagnosis
Category
Details
Documents
Submitted
Your application has been sent for review.
Your application will be reviewed within two business days. A member of our Care Team will contact you if additional information is needed.
2
You will receive notification by phone, mail, or e-mail regarding the final status of your application.
3
If approved, assistance will typically be provided
within 72 hours.
Questions?
Have additional questions or need help with your application? We’re here to help. Contact us or see frequently asked questions.