MSU Myositis Patient Financial Assistance Application Logo
  • Myositis Patient Financial Assistance Application

    Emergency Assistance for Myositis patients. Please read to learn about our program and what is required.
  • Emergency Assistance

    Myositis Support and Understanding (MSU) works hard to assist applicants in addressing financial difficulties in a fair and sensitive way. We offer assistance intended only for emergencies and challenging short-term financial situations, including help with medical bills, limited household expenses, and mobility/assistive devices. We also offer medical travel financial assistance to help alleviate travel burdens for U.S.-based patients traveling to approved research and teaching hospitals within the U.S. that specialize in Myositis. 

    To be eligible for financial assistance, the patient must be diagnosed with one of the idiopathic inflammatory myopathies (Myositis) or be going through the diagnostic process in which doctors strongly suspect and are testing the patient for Myositis.

    Details and Eligibility 

    • Financial assistance is only available for residents of the U.S.
    • Myositis patients may request assistance up to $2,000.00. This is not a guarantee that awardees will receive the full amount.
    • Applications that are incomplete or missing required documentation may not be considered.
    • DO NOT upload medical records. We do not need them.
    • Anyone previously awarded assistance must wait 24 months from the date of their last application before submitting another request.
    • This is NOT a copay program.
    • We process applications on a first-come, first-serve basis and only process applications that include all required information and supporting documents.
    • Payments are made direct to the creditor.   

    Processing your application

    Please allow at least 14 days for the review and processing of your application. To save on costs and time, and to help the environment, we prefer to use email for notifications, application updates, and requests for additional information in order to make a decision for you quickly. However, there is an option on the form to choose US Mail, but we want to remind you that this will significantly slow down your application process. 

    Before you start your application

    There are various supporting documents that are required, depending on the type of assistance you are requesting. However, below is a list of the documents we require from all applicants.

    Please gather copies of the following documents to have ready to upload as you fill out the application:

    • All household members - Last year's tax return (please redact/black-out) your social security number OR the last three (3) pay stubs. For Social Security recipients, provide a copy of the income letter sent at the start of each year. 
    • All household members - Last 2 months of bank statements for all checking and savings accounts. 
    • Personal Statement - provide an short overview of your situation and why you are requesting assistance. This does not have to be formal or lengthy. There is a section where you can type it or upload it.
    • Signed Doctor's Form - Get the form here. Do not submit your application without the signed doctor's form.
    • Full statements/invoices/receipts for ALL bills with which you are requesting assistance. (we do not accept screenshots or payment stubs)
    • In cases of emergency rent assistance, in general, we require a copy of the lease and eviction notice, and a signed letter from the landlord. More details are available on that page of this form.

    About using this form

    This is a secure online form that you can fill out all at once, or in parts. Each page of the form has a "Save" button which will allow you to save what you have entered so far and come back later to complete the application. You must complete the application within 10 days or it will reset - something out of our control. You will receive an email containing the link to return to your application. (Be sure to check your spam/junk folders)

    Please be advised that submitting this form is not a guarantee of approval of assistance.

    * Financial Assistance is subject to eligibility and funding availability.
    * Access the Financial Assistance Help Guide for additional information about application fields.

    Data Privacy - We take your privacy seriously at MSU. Your information is stored on secure servers. We do not share or sell your information with third-parties except information required to make payments to your creditors. This is only limited to what is absolutely required to make the payment. 

    If you have everything you need, click next below.

  • Applicant's Information

    Provide us with your contact information in this section
  • Filing for someone else

    If the patient is unable to complete this application, please complete the following section. Request for assistance for anyone under the age of 18 will require a parent or guardian's signature and a copy of the minors birth certificate.
  • Providing your documents

    What we require you to upload depending on your situation:

    • Child's Birth Certificate
    • Power of Attorney (POA) documentation
    • Any other legal documents
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  • About your diagnosis

    Information about your diagnosis and treating doctor
  • Upload the signed doctor's form below

    If you don't have the form to send to your doctor, Get the form here. 

    Please DO NOT submit the application without the signed form. You can click "Save" and come back later to complete your application.

    If your doctor would like to fax it to us, our fax number is 888-696-7273.

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  • Your Income Details

    Information about your finances to help determine eligibility
  • Your Bank Accounts

    In the field below, please enter all bank accounts, including checking and savings accounts for all members of your household. 

    To use the field below, add your first bank account and click the Save button. This will add your entry and a new line for you to add your next bank account, and so on.

  • Your Income Documents

    The income documents we require for all members of your household are listed below:

    • Last year's tax return (please redact your social security number before uploading) OR the last 3 pay stubs. If on Social Security, a copy of the income letter received at the start of the year. 

      PLUS

    • Last 2 months of all bank statements, including checking and savings accounts.

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  • Types of Assistance

    Choose the type(s) of assistance you are requesting
  • This section of the application is asking you to select what type of financial assistance you are requesting. As you move forward, please only answer the assistance sections that apply to the type of assistance you are requesting.

    The maximum amount you can request per application is $2,000 (two-thousand dollars). This is a total of all categories.

    Select the type or types of assistance you are requesting below. 

  • Emergency Household Expenses

    Please skip this section if you are not requesting in this category
  • Emergency Household Expenses are defined in a case-by-case situation but may include utility bills, or rent payments, etc. Use the field below to enter the bills you are requesting assistance with and the amounts. Then, in the upload field, provide us with full copies of the statements/invoices/receipts. We do not accept screenshots, we require full copies of all bills. 

    Statements/Invoices must include the company payment mailing address, telephone number, amount due, and account number. If a telephone number is not included on the bill, please provide us with this information as it is required for us to make payment on your behalf. 

    Rent payment assistance - Emergency requests only 

    If your request for financial assistance includes emergency rent payment assistance, please note the additional required documents listed below. The landlord can send these items directly to us via email (Office@Understandingmyositis.org) or fax (888-696-7273) or provide them to you to upload with this application. 

    We are not able to provide assistance with security deposits. Rent assistance is provided on a case-by-case basis. We may verify property records in cases where the documents received are insufficient.

    Rent assistance is divided into two categories: rentals from property management companies and rentals from other or private sources. 

    Rent payment assistance documents required

    If you are renting from a property management company, provide:

    • A copy of an eviction notice if provided by the landlord;
    • A valid signed copy of your lease.
    • A letter from the property management company on company letterhead that includes how much you currently owe, payment mailing address, account number, phone number and whether the company will accept a check payment from MSU.

    If you are renting from a private, non-commercial source, provide

    • A copy of an eviction notice if provided by the landlord; 
    • A notarized letter from the landlord that includes the payment mailing address, telephone number, and the amount of the monthly rent, and the amount you are past due and if the landlord will accept a check payment from MSU.
    • A valid signed copy of your lease. 
  • Upload Emergency supporting documents

    Below, upload all emergency bills/statements. These must be full statements. We do not accept screenshots.

    If requesting rent assistance, be sure to also upload the documents required listed at the top of this page.

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  • Medical Bills

    Please skip this section if you are not requesting in this category
  • Medical Bills are defined as bills payable for Myositis-related medical diagnosis, treatment, and care to pharmacies (or formularies) for prescriptions, accredited hospitals, labs, Licensed Medical Doctors, Doctors of Osteopathy, urgent care centers, and other like institutions. This is not a co-pay program. These are not reimbursable expenses.  If approved, we will pay directly to your creditor(s) according to a recent statement you provide to us. We do not accept screenshots. 

     

    What if my health insurance company has not paid its part?

    Please contact your insurance company first to determine if they are going to cover a portion of the bill and when their payment will likely be applied. If they are going to cover a portion of the bill, please wait until you receive a statement showing the insurance payment applied and the updated balance due. Then, submit your financial assistance request with the updated statement.

  • Upload supporting documents

    Below, provide us with a copy of all medical bills/statements and/or receipts. These must be full documents. We do not accept screenshots or payment coupon stubs.

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  • Mobility Device

    Please skip this section if you are not requesting in this category
  • Mobility/Assistive Devices are defined as devices that help people with Myositis enjoy greater mobility, freedom, and independence and include things such as wheelchairs, power wheelchairs, stair lifts, Hoyer lifts, ramps, transfer devices, certain home and bathroom modifications, portable showers, and others.   

     

    Since mobility and assistive devices vary based on need and complexity, applications will be determined on a case-by-case basis, using multiple factors including medical need as determined by your doctor, device purpose, health insurance coverage, and if the device meets a definition of standard devices likely to be covered under an assistance program. 

     

    Please upload a copy of the insurance approval or denial

    • If you submitted the device through health or other insurance, provide a copy of the documents you received showing costs and coverage.
    • For Medicare applicants with a supplemental policy - Did your supplemental (secondary) insurance deny coverage for the device? If so, have you appealed the decision? Please provide any details regarding these questions in a brief personal statement or as a part of the letter mentioned in a previous request above.

    You may apply for pre-approval and if approved, arrangements can be made to pay the creditor directly or to potentially reimburse you if you provide a copy of the original receipt, as well as all other documents related to the purchase. Reimbursement may not be made without prior approval. 

  • Upload Mobility Device Documents

    Please upload ALL documents relating to the device you are requesting assistance for. This should include: 

    • Submit a brief letter with additional device details, any special considerations, and include how this device will improve your ability to function.
    • Include a letter from your doctor or other qualified medical personnel (PT, OT etc.) confirming your need for this device.
    • Submit an invoice, receipt, statement, or other document that provides the mobility device details, including cost, mailing information for payments, the company telephone number, and a contact person where applicable. Screenshots from online accounts are not acceptable.
    • Submit a letter from the vendor indicating that they will accept direct payment from MSU for your device. 
    • If your device costs over $2,000, include a statement certifying that you will commit to covering the remaining costs. 
    • Include any special information we need or anything we need to add to the memo line of a check to ensure proper payment to the vendor.
    • If you submitted the device through health or other insurance, provide a copy of the documents you received showing costs and coverage. 
    • For Medicare applicants with a supplemental policy - Did your supplemental (secondary) insurance deny coverage for the device? If so, have you appealed the decision? Please provide any details regarding these questions in a brief personal statement or as a part of the letter mentioned in a previous request above.
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  • Medical Travel Assistance

    Please skip this section if you are not requesting in this category.
  • Eligibility

    Patients: Those seeking treatment at approved facilities. Note that clinical trials, experimental treatments, and second opinions are excluded from coverage under this policy. 

    Caregivers: Caregivers accompanying patients are eligible for assistance if their presence is necessary for patient safety during travel (e.g. if the patient is unable to travel independently due to the condition). 

    Approved Facilities

    Travel assistance is provided only for trips to MSU pre-approved clinics specializing in Myositis treatment. A list of these approved facilities is available on the MSU website and is updated annually. 

    Exceptions to the list of approved facilities may be considered on a case-by-case basis with prior approval from MSU. 

    Eligible Expenses

    MSU provides financial assistance for the following expenses, subject to verification and within the prescribed limits:

    1. Transportation:

    1. Airfare: Reimbursement for coach class airfare with receipts. 
    2. Mileage: Reimbursement at the current IRS medical mileage rate. Documentation of mileage is required. 
    3. Rental car: Reimbursement for rental car to get from airport/bus/train station to hotel & medical facility with receipts, if needed.
    4. Public Transportation: Costs for bus, train, or other public transport with receipts.
    5. Local Transportation: Travel between lodging and facilities is not covered.
    6. Parking: Airport and Hotel parking with receipts.

    2. Lodging: 

    1. Reimbursement for lodging up to the federal per diem rate for the destination. Please refer to GSA Per Diem Rates for details. 
    2. Lodging can be at a hotel, motel, Airbnb, or VRBO, as long as the rate does not exceed the federal per diem rate. The limit is one room per day.
       

    3. Meals: 

    1. Meal reimbursement is capped at the Federal Meal & Incidental Expense (M&IE) rates, available at GSA M&IE Breakdown.
    2. Alcoholic beverages are not reimbursable. Receipts are required for all meals.

     4. Caregiver Costs: 

    Caregiver travel and meal expenses are eligible for reimbursement, but they must be pre-approved and follow the same reimbursement guidelines as those for patients. 

    Applicants are encouraged to select the most cost-effective options for travel, lodging, and meals to minimize expenses.

    Application Process:

    To apply for assistance, applicants must provide the following documentation: 

    1. Doctor Certification: Proof of Myositis diagnosis. 
    2. Financial Need: Proof of financial need in accordance with MSU’s Financial Assistance Guidelines. For more details, please refer to the MSU Financial Assistance Guide. 
    3. Clinic Appointment Confirmation: A verified and scheduled appointment at an MSU-approved facility. 
    4. Estimated Costs: An itemized estimate of travel, lodging, and meal costs. Pre-booking receipts are encouraged for verification. 
    5. Completion Proof: Documentation confirming the appointment occurred (for reimbursement).
    6. Applications are reviewed by MSU’s financial assistance committee. Applicants will be notified of the outcome within a reasonable time frame.

     

    Funding Limits and Reimbursement:

    • Award Cap: A maximum of $2,000 in financial assistance is available on a rolling two-year basis per patient or caregiver.
    • Pre-Approval: Travel expenses must be pre-approved to ensure eligibility and proper budget allocation. 
    • Vendor Payments: MSU will directly pay vendors (e.g., airlines, hotels) when possible. MSU can not guarantee payment within the 24 hour limit that transportation vendors typically allow. Applicants requiring assistance in prepayment are encouraged to submit (step 2) transportation needs (vendor details and contact information) for MSU to book travel directly for you.
    • Documentation: For expenses not paid directly by MSU, applicants must submit receipts for reimbursement. These expenses must comply with MSU’s guidelines and the federal per diem rates. 


    Supplements to Approved Travel


    Reimbursement for meals and other non-pre-paid expenses will occur via check upon submission of receipts and documentation, provided expenses comply with program guidelines. 

    Cancellation Policy 


    If an appointment is canceled before the vendor refund deadline, unused pre-paid funds must be refunded to MSU. If the appointment is canceled and not rescheduled, all funds must be returned to MSU immediately.

    In cases of medical emergencies or situations beyond the applicant’s control (e.g., hospitalization, sudden health complications), applicants may request an extension or exception to the cancellation policy. 

    Payment Proceedures

    A.    Advance Payments: Advance payments for expenses may be approved in advance of travel, subject to pre-approval and adequate documentation. 

    B.    Direct Reimbursements: Payments for eligible expenses will be made via direct reimbursement after the completion of travel, contingent on the submission of valid receipts and documentation within 30 days of travel. 

    Fraud Prevention

    To maintain the integrity of the program, the following measures will be enforced: 

    • Receipts Required: All claims must include detailed receipts. 
      Audits: MSU reserves the right to audit expenses to ensure compliance with the policy. 
    • Verification: Expenses will be verified against GSA per diem rates and MSU’s policy guidelines. 
    • Penalties:  Failure to provide the required documentation or submission of fraudulent claims will result in disqualification from future assistance under all MSU Financial Assistance programs. 

    Disclaimer 

    This policy is subject to periodic review and updates based on program feedback, changes to government per diem rates, and the evolving needs of patients and caregivers.  Any updates to the policy will be posted on the MSU website. 

  • Travel Authorization Steps:


    Step 1: You will need to fill out the Pre-Authorization information prior to the appointment. The financial team will review your request and issue an approval if you qualify.

    Step 2: Once approved, if you need assistance in paying for your transportation and/or lodging prior to the visit, you will provide the travel information needed to make reservations through MSU.  

    Step 3: When  travel has been completed, you will come back to the application to submit final receipts for reimbursement

  • Appointment Information:

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  • Pre Approval Information:

    The following information is needed:
  • For reference: 

    GSA Per-Diem for lodging

    GSA Meals

    IRS Medical Mileage   (2025 rate is $0.21)

  • Prepayment Assistance is needed

    Skip this section if no financial assistance is needed up front of travel. Fill out the following information if assistance in paying for transportation or lodging is needed. The information will be provided to MSU to make the arrangements, and you will receive notification of reservations made. Skip this section if no financial assistance is needed up front of travel.
  • Post Appointment Verification and Payment

    When the appointment has been kept applicant is required to provide MSU with verification that the appointment was kept. Additional monies will be sent to pay credit cards and to applicant for out-of-pocket expenses.
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  • Transportation and Lodging Information:


    Once travel has been completed, please fill out the following and attach necessary receipts.   If transportation or lodging was prepaid by MSU, do not reenter information. 

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  • Meals: 


    Meals will be reimbursed based on actuals but limited to the maximum of actual cost and per diem amounts based on GSA rates. Receipts are required. 

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  • Personal Statement

    Tell us more about your situation to help us better understand. You can either upload your personal statement or type it in the box below. As with everything about this process, your personal statement is private and confidential.
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  • Finalizing your application

    Please share any added information or documents that you feel will help us in our decision. Also, if you have all of your supporting documents in one PDF or ZIP file, please upload that in this section. DO NOT include medical health records.
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  • Documentation Preferences

    To save on costs, time and to help the environment, we strongly prefer to use email to communicate with you about your application. There are times where we request additional information or documentation and mailing back and forth is timely and will delay your application. However, if you prefer US Mail, please mark that below. With email, be sure to check your spam email folder. NOTE: If you choose Mail, you will still receive some emails that are a part of the form application process.
  • Waiver and Release

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