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Medical Bill Assistance

The Blake Orlando Foundation assists families facing financial hardship after having a baby in the Level IV NICU within the past 12 months. Our goal is to help relieve some of the financial burden so families can focus on what matters most — their baby.

 Applying does not guarantee assistance. All requests are reviewed based on need and available funds.  To apply, please fill out the application below.  We look forward to helping, from our family to yours.

Medical Financial Assistance Application

Please complete all sections. Submission of this application does not guarantee assistance.

Applicant Information

NICU Verification

To be eligible, the infant must have received care in a Level IV NICU within the past twelve (12) months.

Financial Hardship Information

Please describe the financial hardship related to your infant’s NICU stay (check all that apply):
Type of assistance requested (check all that apply)

Household Information

Income documentation may be requested but is not required at initial submission.

Required Attestations

Please read each statement carefully

Non-Discrimination Statement

The Blake Orlando Foundation does not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, disability, or national origin.

Legal Disclaimer

The Blake Orlando Foundation is a charitable organization and is not responsible for unpaid balances, billing disputes, or services rendered by third-party providers. Assistance decisions are final and not subject to appeal.

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Frequently asked questions

The Blake Orlando Foundation’s Medical Financial Assistance Program is a charitable program intended to provide limited financial support to eligible families. The Foundation is not a medical provider, insurer, or financial institution, and does not provide medical advice, legal advice, financial counseling, or insurance coverage. Submission of an application does not guarantee approval or assistance. All assistance is provided at the sole discretion of the Foundation based on eligibility, demonstrated need, and availability of funds. The Foundation may request additional documentation, verify information provided, and decline assistance for any reason consistent with its charitable mission and applicable law. The Foundation reserves the right to modify, suspend, or discontinue the program at any time without notice. If assistance is provided, payments are generally made directly to medical providers or approved vendors. The Foundation is not responsible for any billing disputes, late fees, collection actions, service denials, or unpaid balances between applicants and third-party providers. Applicants are solely responsible for confirming any amounts owed and for communicating with hospitals, providers, or vendors regarding billing and services. In case of emergency, contact your healthcare provider or call 911. This program is not intended for emergency or urgent needs.

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