Author: Qualify Health

West Palm Beach, FL— October, 12th 2022. Monique Lappas, Founder and Chief Executive Officer, Kapra Lott, Chief Business Development Officer and Kelly Sanders, Chief Operating Officer represented Qualify Health at the recent Association of Community Cancer Centers at their 39^th National Oncology Conference.

The conference was held at the West Palm Beach Convention Center , in West Palm Beach FL

The event was attended by over 200 representatives for oncology provider practices, hospitals and industry.

The Qualify Health booth drew participants to their booth, who enjoyed the espresso and cappuccinos on offer at the booth, from as far away as Seattle, WA and North Dakota, all the way through to local Florida based practices. The conversations ranged from the prior authorization services and overcoming internal hurdles at understaffed practices, through to the financial and patient benefits of a wide-ranging and robust financial advocacy service.

The Association of Community Cancer Centers (ACCC) is a powerful community of more than 28,000 multidisciplinary practitioners and 2,100 cancer programs and practices nationwide.

Founded in 1974, ACCC brings together healthcare professionals across all disciplines in oncology to promote quality cancer care. It is estimated that 65 percent of the nation’s cancer patients are treated by a member of ACCC.

Qualify Health is one of the country’s leading technology and service providers for healthcare-based financial advocacy solutions and AI-driven prior authorization Solutions.

Columbus SC— September 15^th, 2022. Monique Lappas, Founder and Chief Executive Officer, , of Qualify Health presented at the Association of South Carolina Oncology Managers (ASCOM).

The conference was held at Columbia  Metropolitan Convention Center , Columbia SC

The event was attended by over 40 representatives from some of South Carolina’s leading Oncology Providers, as well as other industry executives.

The topic of Ms. Lappas’ presentation was “Growing Your Revenues and Bringing Your Patients to Tears (OF JOY!)”, in which she presented case studies of the impact that Qualify Health’s software and service solution can drive financial advocacy, increased advocacy dollars, improved patient satisfaction and the company’s AI-Driven Prior Authorization platform to solve the increasing burden of Prior Authorizations.

The association of South Carolina Oncology Managers is a non-profit professional organization that provides access for oncology practices to quality leadership development through continuing education, networking, and business improvement opportunities

Qualify Health is one of the country’s leading technology and service providers for healthcare-based financial advocacy solutions and AI-driven prior authorization Solutions.

What is a Copay Assistance Program?

As healthcare costs continue to rise, patients are looking for ways to save on medication costs. Providers want to make sure they get compensated for any patient out-of-pocket expenses due to them. When insurance is not enough to cover the total cost, patients struggling to afford expensive drugs turn to Manufacturer Copay Assistance Programs or Copay Cards to help with the out-of-pocket expenses. Pharmaceutical companies typically offer these programs. The program’s purpose is to help people with commercial or private insurance cover their deductibles, copays, and co-insurance directly related to the cost of their prescription drugs.

How do Copay Assistance Programs work?

Copay Cards reduce the total out-of-pocket expenses for the patient. Once approved for the program, the patient’s insurance is billed first and covers some of the drug’s cost, then the manufacturer covers most, if not all, of the remaining out-of-pocket expense.

How to apply for a Copay Assistance Program?

If your physician practice or specialty pharmacy does not partner with someone like Q Consulting Services, then the patient can access Copay Card programs through the manufacturer’s website. To sign up for the program, they will register online, or call the program to enroll. Once you are enrolled, you are provided with your member information and possibly a credit card to use at your pharmacy or provider’s office– this varies among programs.

If your practice/specialty pharmacy partners with a company like Q Consulting Support Services (QCSS) , we will sign up the patient and maintain their membership, and give you and the patient any information they need.

What are the requirements or restrictions?

For most Copay Card Programs, there are two main requirements:

1. The patient must have commercial or private insurance.

2. You cannot have government health insurance, such as Medicare, Medicare Advantage Plans, or Medicaid.

How to receive reimbursement for out-of-pocket expenses?

There are three possible scenarios:

1. The patient is filling their prescription (e.g., Humira) at the provider or hospital-owned specialty pharmacy. The pharmacist will process the patient’s insurance as the primary payer and the copay card as the secondary payer. The Copay Card Program may cover the out-of-pocket expense in its entirety, or the patient may be responsible for a tiny portion – generally around $5.

2. The patient is receiving an infusion (e.g., Herceptin, Stelara) at an out-patient facility. The facility will bill the primary insurance for the drug. Once the insurance company pays its portion, the explanation of benefits (EOB) will indicate the patient’s out-of-pocket expense. The patient is then responsible for submitting the EOB to the program. When the claim is approved, the program will mail a check or upload the reimbursement to a credit card.

3. QCSS can manage the entire reimbursement process, from electronically receiving the EOB as soon as the billing occurs, to and ensuring that the charge is loaded on the copay card and making sure the physician office is paid by either managing check requisitions or running the copay cards through your POS.

How do patients and healthcare professionals benefit from Copay Assistance Programs?

Copay Assistance Programs lessen the patient’s financial burden, making it easier for them to obtain their prescription and ensure that the appropriate treatment is attainable.

Q Consulting Support Services specializes in the management of Copay Card programs. Our dedicated staff partners with clients ranging from small oncology practices to the country’s largest healthcare systems. Our Support Service team enrolls the patient into the Copay Card Program, monitors and submits EOBs with patient out-of-pocket expenses, and follows-up on any denials to ensure payment is received promptly. Ultimately, increasing patient satisfaction and reducing the financial burden on the provider’s office or facility by guaranteeing patient out-of-pocket expenses are obtained, which reduces bad debt and increases revenue.

How to find Foundation Assistance for patients

Foundation Assistance for Chronic or Life-Altering Diseases

Foundations offer financial assistance to those suffering from Chronic or Life-Altering Diseases when insurance is not enough to cover the treatment. Foundations help fill the gaps by assisting patients with their out-of-pocket expenses.

What is Foundation Assistance, and Who offers it?

Non-profit organizations like The Leukemia & Lymphoma Society, Healthwell Foundation, and the PAN Foundation, to list a few, provide financial assistance to patients in need. These foundations offer specific disease funds and award assistance to patients via grants. The grants awarded may cover copays, deductibles, insurance premiums, co-insurance and may help with travel or household expenses.

Who is eligible for Foundation Assistance?

Available funding is disease-specific – you must be diagnosed with the disease, be actively receiving treatment in the United States, have insurance covering the medication and therapy, and fall within a certain percentage of the Federal Poverty Level Guidelines (FPL). Unlike Manufacturer Copay Assistance Programs, Foundations allow applicants to have Federally Funded insurance like Medicare and Medicare Advantage plans.

If your practice/specialty pharmacy partners with a company like Q Consulting Support Services (QCSS), we will enroll all qualified patients, maintain their enrolment, and manage the entire billing and collections process.

How to apply for Foundation Assistance?

Disease fund availability is dependent upon whether there is sufficient funding available. Funds open and close daily, making the application process more difficult than other financial assistance programs. If a fund is accepting applications, you should apply immediately.

Step 1: Gather Information for the application.

• Demographics (including Social Security Number)
• Diagnosis
• Estimated household financial income
• Insurance information
• Pharmacy contact information
• Treating physician contact information

Step 2:

• Apply online or over the phone.

Alternatively, QCSS can manage the entire process, from enrolling patients as soon as a fund opens and helping them manage their financial paperwork to ensure all claims are submitted and reimbursed promptly.

How much financial assistance can I receive, and how is it paid out?

The award levels range from $100 to over $10,000 per applicant, depending on the fund. The full grant amount is allocated over one year and reimburses for services and treatments rendered during this period via the fund’s reimbursement process.

Keeping your grant active

Foundations want to ensure that grants are being used by those actively receiving treatment and in need of financial assistance. Many foundations require initial reimbursement requests to be submitted within a specific time frame and do not allow extended periods of inactivity, or the awardee could lose the grant completely. The time frames vary between 90-120 days.

Q Consulting Support Services specializes in managing Foundation Grants for our clients. We actively monitor Foundation sites to apply for our patients as soon as a fund opens up. Additionally, we ensure that all reimbursement requests are submitted timely so that our patients do not lose their funding and may continue to pay their providers for services rendered.

How helping patients find financial advocacy improves patient satisfaction and reduces bad debt

How Patient Financial Advocacy Improves Patient Satisfaction and Reduces Bad Debt

Patient Financial Experience

The patient financial experience within the U.S. Healthcare System is unique due to the variety and complexity of the different payer-systems. A patient’s expectation of their medical bill being as straightforward as the treatment should not be unrealistic. However, it is not of this time. In combination with the complex nature of medical bills, the patient’s out-of-pocket responsibility has increased due to high deductible and high-cost sharing insurance plans.

A TransUnion Healthcare analysis revealed that patients are, on average, experiencing at least a 10% increase in average annual out-of-pocket costs, and the average burden on each patient is approximately $2,000 – an unaffordable hurdle for most patients that is leading to millions of dollars of bad medical debt for the average healthcare system.

Given the constant media attention about the burden of healthcare costs, patients are increasingly expecting their practitioner to either help them with patient financial advocacy or absorb some of the patient’s financial burden due to financial hardship. Therefore, it is in the best interest of all parties for the physician/hospital/pharmacy to provide financial advocacy services in tandem with clinical services to improve revenue recovery and patient loyalty.

Patient satisfaction and patient experience are inextricably linked. As patient out-of-pocket responsibility continues climb, the medical practices that take proactive measures to help meet the patient’s financial needs and improve the patient experience will be the practices to prosper.

Any practice that has attempted to provide in-house patient financial advocacy soon comes to realize the administrative burden that it puts on existing staff, and often are required to hire additional FTE’s to manage these programs on behalf of their patients. This is where Q Consulting Support Services steps in.

Q Consulting Support Services specializes in providing Financial Advocacy to help patients with the out-of-pocket expenses associated with treatment. Our dedicated staff partners with clients ranging from small oncology practices to the country’s largest healthcare systems. Our Support Service team applies for funding on the qualifying patient’s behalf through grants and financial assistance programs. After funding approval, we monitor and submit EOBs with patient out-of-pocket expenses, and follows-up on any denials to ensure payment is received promptly. Ultimately, increasing patient satisfaction and reducing the financial burden on the provider’s office or facility by guaranteeing patient out-of-pocket expenses are obtained, which reduces bad debt and increases revenue.

How QCSS was able to secure over $16,000 in financial advocacy for this patient

Patient Overview: Mr. V.

Like many newly diagnosed cancer patients, Mr. V’s life took a frightening detour when he was diagnosed with Locally Advanced Pancreatic Cancer at the age of 56. When he began treatment, he only had Medicare Part A benefits and had recently lost his job due to the COVID-19 Pandemic. His household income, which included his unemployment and his wife’s income, totaled about $2,000 a month, putting him at around 150% of the Federal Poverty Level.

Medication & Cost

The oncologist prescribed our patient Abraxane, Gemzar, and Creon to treat his Pancreatic Cancer and after consultation with Q Consulting Services and the hospital, he learned that his medications were going to cost him more than $12,000 a month, and did not have appropriate insurance coverage to help with the expense. For this couple on a fixed income, the cost would be impossible to cover. It was at this point that the hospital’s oncology business asked Q Consulting Support Services (QCSS) to step in, with the request that we help the patient avoid incurring an untenable amount of debt and assist the hospital in being reimbursed, where possible, for Mr. V’s treatment.

Outcome

The patient worked on getting additional insurance coverage and signed up for Medicare Part B., while QCSS simultaneously secured free drugs for Abraxane and Creon.

QCSS understands that a patient’s focus should be on their recovery while the physicians, nurse and hospital’s focus should be on patient care. With this in mind, we fully managed the entire enrollment, billing, and ordering process throughout Mr. V’s treatment, alleviating our client, The Greater Baltimore Medical Center, and the patient from this added burden. The patient received his medication for free, and our client avoided a potential loss of over $12,000 a month.

Once the patient secured his Medicare Part B insurance, QCSS then obtained a fund through the PAN Foundation to cover his 20% out-of-pocket expenses. Our client would be able to bill and receive reimbursement through Medicare, while our patient’s out-of-pocket costs were also fully covered.

This patient required more assistance due to the circumstances of his unemployment. QCSS provided further assistance by finding alternative funding options like The Good Days Emergency Relief Fund to help this patient with household expenses and utility payments.

Over three months, we were able to secure over $16,000 in financial advocacy for this patient. This patient was so appreciative of our services and the financial assistance we were able to provide through one of the most challenging times of his life. He focused on his health instead of stressing over the burden of expensive healthcare treatment

How QCSS was able to help Michael with $42,000 of medication costs

Patient Overview: Michael

Michael is a 50-year-old father of three with a combined family income of over $175,000 per year, who, in October 2020, was unexpectedly diagnosed with Chronic Myeloid Leukemia (CML). Michael had always been a healthy person and was not on any chronic-care medications, so while he had a great insurance plan, he had opted out of prescription coverage.

Upon learning of his diagnosis, Michael immediately enrolled in the insurance plan’s prescription coverage, but it would not become effective until January 2021

Medication & Cost

To Treat Michael’s CML, his Oncologist prescribed a Sprycel, an oral chemotherapy medication with a retail price of $14,130 for a 30-day supply, or, for Michael, a 3-month out-of-pocket cost of $42,390.

Michael was faced with either finding a way to afford his medication, choosing an alternate but less optimal medication, or delay treatment until his prescription plan began. The oncologist felt strongly that the patient begin the medication without delay but also understood the financial burden that it placed on Michael, so he contacted Q Consulting Support Services (QCSS) to help the father of three figure out what options might be available for affording this life-saving treatment.

The drug manufacturer offered a 30-day free trial, so QCSS immediately enrolled the patient into this option.

Challenges to Patient Assistance Program

The biggest hurdle in helping Michael with securing the next two months of medication at a price that he could afford was the combined family income of $175,000 a year. This level was above 500% of the Federal Poverty Level and pushed him outside of the eligibility level for the drug manufacturer’s patient assistance program (PAP).

October’s prescription was taken care of by the 30-day free trial, we QCSS had 30 days to figure out how we would secure November and December’s medication. After speaking with the territory pharmaceutical representative and stating the patient’s case, we learned that the only hope for assistance was through the manufacturer’s patient assistance program, despite his ineligibility

The Final Appeal

Even though the patient did not meet the income qualifications for assistance, we moved ahead with the application. QCSS’s Patient Service Advocate spent hours on the phone with the manufacturer’s PAP explaining the patient’s unfortunate circumstances. The foundation denied the patient’s application and notified us that the only remain would be to file an appeal on the patient’s behalf.

QCSS was transparent with both the patient and the physician throughout the entire process. There was no guarantee that we would be successful, but would do our best and go above and beyond in ensuring that all information about the patient and the financial hardship that would result in treatment was submitted. However, until the final appeal was heard, there was uncertainty if Michael would be able to continue his treatment and we wanted to ensure that both physician and patient were emotionally prepared for another denial.

A Successful Outcome

With this last-ditch option, many more hours on the phone, filling out applications, submitting financial documents, and making the patient’s case to the drug manufacturer, the free medication was approved!