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FAQs

About Qualify Health

What does Qualify Health do?

We automate the process of matching hospital patients to financial assistance programs from fund identification through payment collection.

Our software identifies a hospital’s patients eligible for financial aid, then matches them to relevant funding sources, including foundation grants, co-pay assistance cards, and free drug programs. We manage the entire application and payment process, so your team doesn’t have to. The result: recovered revenue, reduced bad debt, and significantly less administrative burden on your staff.

Who is Qualify Health built for?

U.S. hospitals, specialty pharmacies, and infusion centers, particularly those serving uninsured or underinsured populations.

Our typical partners are non-profit community hospitals with high volumes of patients facing out-of-pocket treatment costs. We’re particularly effective in departments with high patient financial burden, such as oncology, where 25% of cancer patients skip recommended care due to cost. We work with hospitals of varying sizes, from community hospitals to large regional medical centers like Greater Baltimore Medical Center.

Is Qualify Health a vendor or a partner?

We are a vendor and operate as your partner. Our pay-for-performance model means our success is directly tied to yours.

Unlike traditional software vendors, we don’t charge upfront fees or subscriptions. We earn revenue only when we successfully recover financial assistance funds for your patients. This aligns our goals with your financial and patient care outcomes. We also work alongside your existing patient advocacy, billing, and pharmacy teams.

Who founded Qualify Health?

Qualify Health was founded by Monique Lappas, a healthcare finance executive with over 20 years of experience, a CFA designation, and an MBA from Dartmouth’s Tuck School of Business.

The company is female-owned, and US-based. The leadership team includes experts in sales and patient access operations, clinical nursing, and healthcare technology; bringing a cross-functional perspective to solving hospital financial challenges.

What hospitals has Qualify Health worked with?

Our partners include Baptist Health, Grady Health, Monument Health, Greater Baltimore Medical Center, Thibodaux Regional, Ellis Medicine, Forest Health, HaysMed, and others.

We work with hospitals across multiple states, ranging from large community medical centers to regional health systems and oncology networks. Case studies and customer stories from cancer treatment centers and various hospitals like GBMC, Baptist Health and Forrest Health are available on our website detailing financial outcomes and implementation details.

How it works

How does the matching process work?

Our software identifies patients who may be eligible for financial assistance, then matches them to the most relevant funding sources.

Here’s the step-by-step process: First, the platform syncs information from your EMR to identify patients with outstanding balances or upcoming treatments. It then cross-references each patient’s diagnosis, treatment plan, and financial situation against thousands of available funding programs. When a match is found, Qualify Health manages the application and follows through to payment collection. The system runs continuously, monitoring for new funding openings in real time so no eligible patient is missed.

What types of funding does Qualify Health match patients to?

We source from over $30 billion in available funding across foundation grants, co-pay assistance cards, free drug programs, and federal and state programs.

The funding landscape is complex and constantly shifting, programs open and close rapidly, eligibility criteria change, and new sources appear regularly. Our platform continuously monitors this landscape so your team doesn’t have to manually track thousands of programs. We match patients to the most relevant and time-sensitive options based on their specific clinical and financial circumstances. And we wait-list patients for eligible funding as well as do follow-ups for submitted applications.

Can Qualify Health recover revenue from past patient accounts?

Yes. Retroactive matching is one of our key differentiators; we can scan up to 12 months of historical patient records to identify previously missed eligibility.

Many hospitals have significant past-due balances sitting on their books that could have been covered by financial assistance programs. Our retroactive matching capability identifies those missed opportunities and recovers revenue that would otherwise be written off as bad debt. At one oncology treatment center, this capability contributed to $1.3 million in recovered past-due revenue within the first year.

Does Qualify Health handle the full process, or just the matching?

Full cycle, from fund identification and application through to payment collection.

This is an important distinction from some other solutions that stop at eligibility identification. Qualify Health manages every step: sourcing funds, verifying patient eligibility, completing and submitting applications, tracking approvals, and collecting payments. This full-cycle management is what allows us to deliver measurable financial results rather than just reports on potential eligibility.

Does your system work in real time, or only on historical data?

Both. We match retroactively on past accounts and monitor ongoing cases and new funding openings in real time.

The real-time monitoring component is especially valuable for time-sensitive funding. Foundation grants and assistance programs can open and close within hours or days. Our platform catches those windows and applies on behalf of eligible patients immediately, ensuring no funding opportunity is missed. This combination of retroactive recovery and real-time capture maximizes total revenue recovered.

Patient Experience & Staff Workflow ​

We already have a team that does this work, how do you work with existing teams?

Qualify Health is designed to support your existing patient advocates and financial counsellors, as much as you need. Some hospitals select certain aspects of the financial sourcing (e.g. foundations) while others prefer to have our software manage all the burdensome aspects of finding, applying and securing payment so that patient advocates and financial counsellors are freed up to educate and work with the patient.

Our software and customer success reps handle the time-consuming administrative work of fund sourcing, application management, and payment tracking, freeing your existing advocates to focus on direct patient interactions, complex case management, and relationship-building. Hospitals consistently report that their advocacy staff are relieved rather than threatened, because the work we take off their plate is the work they wanted off in the first place. We coordinate directly with your team on case-by-case questions, but your advocates remain the primary patient relationship owners at the hospital.

How do you obtain patient consent to apply for assistance on their behalf?

We obtain signed patient consent through standard consent forms before applying for any financial assistance program.

Consent is collected as part of our intake workflow. Once a patient is identified as potentially eligible, our advocate team secures the patient’s signed permission to seek financial assistance on their behalf. This consent process complies with foundation, pharmaceutical, and federal program requirements and is documented in your EMR. We coordinate consent collection with your existing patient registration and financial counseling workflows so it does not add steps for your staff. For those patients where we’re obtaining past-due/retroactive funding we will connect via phone, email and text.

What kind of reporting will we receive?

You receive monthly performance reports plus weekly payment reports sent directly to your billing team.

Our monthly reports include quantified monthly performance, historical trending, project updates on factors affecting outcomes, and patient impact stories. Weekly payment reports detail each transaction by patient, date of service, drug or service, and funding source (free drug, copay card, foundation, or direct-to-patient assistance), so your billing team can post payments to the correct accounts. Our project leadership team is also committed to responding promptly to ad hoc reporting requests, including data cuts by department, diagnosis, payer, or service line.

Implementation & Integration​

How long does implementation take?

Days, not months. Our no-code integration connects directly with your existing systems with minimal IT involvement.

There is no custom coding, no infrastructure changes, and no disruption to your current workflows. We sync information from your EMR systems quickly to identify eligible patients almost immediately. And our customer success reps can update the patient records in the EMR so you keep all the patient information centralized in one file. Hospitals typically see their first financial assistance matches within the first weeks of deployment.

Will this create work for our IT team?

No. Qualify Health is specifically designed to minimize IT lift.

Our no-code architecture means your IT department does not need to build, configure, maintain, or monitor anything on an ongoing basis. The platform fits securely within your existing hospital IT infrastructure. This is a common concern we hear, and it’s one reason we built the solution the way we did to remove IT bandwidth as a barrier to adoption.

Which EMR systems do you integrate with?

We integrate with all EMR systems, eg Epic, Cerner (Oracle Health), Meditech, and other major EMR and billing systems used by U.S. hospitals.

Our no-code architecture means we receive patient data via secure file transfer rather than requiring a custom API build or middleware on your side. We update patient records within your EMR so you keep all patient information centralized in their file. We have implemented with hospitals running every major EMR in the market and can confirm compatibility with your specific configuration during an initial assessment.

Does our team need training or new skills to use the platform?

No. Your team doesn’t need to do any new tasks. Qualify Health works alongside your existing processes and staff without requiring new skills, certifications, or dedicated personnel.

The automation handles the complex, time-consuming work,  scanning for eligibility, sourcing funds, managing applications, and tracking payments. Your patient advocacy and billing teams continue working as they do now, with less administrative burden.  And our customer success reps can update the patient records in the EMR so you keep all the patient information centralized in one file. We coordinate directly with your staff as needed, but the solution does not require them to learn a new system or change their workflows.

What does our hospital actually need to do during implementation?

Provide a secure data feed (typically SFTP) of patient accounts and authorize the integration. That is the bulk of your team’s involvement.

A typical implementation involves three light-touch tasks from your team: an initial kickoff meeting to align on workflows and reporting, secure data feed setup with your IT or data team (usually a few hours), and review of consent and communication templates with your patient services or compliance lead. Once those are complete, our team takes over. We handle fund identification, application management, patient outreach, and payment tracking. Your existing patient advocates and billing staff continue working as they do today, with less administrative load.

Pricing & Risk​

What is your fee, and how is it calculated?

We charge a percentage of revenue we successfully recover for you, based on actual cash deposited into your accounts. Specific rates depend on services and volume.

Our fee structure is transparent: we invoice only on documented assistance secured and deposited, never on applications submitted or pending amounts. Because this revenue would likely be written off as bad debt, the net result is that the majority of recovered revenue flows directly to your bottom line. We work with your finance team to provide the detailed reporting you can use for internal reporting.

How does the pay-for-performance model work?

There are no upfront fees, no subscription costs, and no implementation charges. We earn a commission only when we successfully recover funds.

You pay nothing unless Qualify Health delivers results. Our commission is based on financial assistance funds we successfully match and recover for your patients. If we don’t recover revenue, you don’t pay. This eliminates the financial risk of adoption and means the solution effectively pays for itself through the revenue it generates.

Is there a contract or long-term commitment?

Our pay-for-performance structure is designed to minimize your financial risk. We can discuss specific terms for your organization directly.

The core principle is the same regardless of contract structure: you don’t pay unless we deliver measurable results. This means there’s no scenario where you’re locked into paying for a solution that isn’t working. We encourage hospitals to contact us to discuss the specific arrangement that fits their needs.

What's the typical ROI?

Hospitals have seen millions in recovered revenue within the first 6–12 months, with up to 70% reduction in bad debt.

At Greater Baltimore Medical Center, we delivered over $1 million in patient savings within six months, with a projected $2 million annual financial benefit and a 70% drop in bad debt. An oncology treatment center recovered $1.3 million in past-due revenue and doubled the financial assistance provided to patients within 12 months. Across our full client base, we’ve recovered over $34 million in charitable advocacy and reduced write-offs by $75 million, helping hospitals support over 15,000 patients. Results vary by hospital size and patient mix, but the pay-for-performance model means your ROI is inherently positive.

What if we already have a financial assistance process in place?

Qualify Health consistently uncovers new funding that other vendors miss. We outperform competitors by 2 to 10 times, consistently.

We’ve been brought in alongside existing internal programs and competing solutions and have delivered significant incremental revenue in every case. Manual processes and even other software solutions typically can’t match the breadth of our fund sourcing (over $30 billion in monitored programs), the speed of our real-time monitoring, or our retroactive matching capability. We augment what you’re already doing, we don’t ask you to rip anything out.

Compliance & Security​

How does Qualify Health handle data security and patient privacy?

We adhere fully to HIPAA and SOC2 with healthcare-grade security protocols throughout.

All patient data processing follows documented lawful basis requirements. Our platform is built with the security standards hospital IT and compliance teams expect, including proper handling of protected health information (PHI). Data security is not an afterthought, it’s foundational to how we built the platform.

Does Qualify Health comply with 340B program requirements?

Our solution complements 340B programs by helping hospitals capture additional financial assistance beyond what 340B covers. We also assist in the related transparency requirements for 340B by enabling hospitals to show how the savings are benefiting patients and their community.

With pharmaceutical manufacturers increasingly restricting 340B access, automated financial assistance matching becomes a critical backup revenue strategy. Qualify Health helps hospitals diversify their financial assistance capture across foundations, grants, co-pay cards, and free drug programs, reducing dependency on any single program. For hospitals participating in 340B, we work alongside those programs without creating compliance conflicts and demonstrating benefits to patients and community.

Results & Impact​

What measurable results have hospitals seen?

Over $34M in charitable advocacy recovered, $75M less in write-offs, up to 70% bad debt reduction, and 15,000+ patients helped across our client base.

Specific client outcomes include: GBMC saw $1M+ in patient savings within 6 months and a 70% bad debt reduction, with a projected $2M annual financial benefit. A cancer treatment center recovered $1.3M in past-due revenue and doubled the financial assistance provided to patients. Individual patients have seen bill reductions exceeding $50,000 through retroactive financial assistance. Baptist Health reported improved patient experience with expedited assistance and recognition by senior leadership for impact.

How does Qualify Health affect the patient experience?

Patients receive financial relief faster, with some seeing bill reductions of $50,000+ and your staff has more time to spend on direct patient support.

Financial toxicity is a serious problem in healthcare: 25% of cancer patients skip recommended care due to cost. By automating the financial assistance matching process, Qualify Health helps ensure more patients receive the treatments they need without financial barriers. Patients have described the assistance as “a true miracle” and “a true blessing.” For your staff, the reduced administrative burden means more time for the patient interactions that matter most.

How does Qualify Health help with the staffing challenges hospitals face?

We reduce the administrative workload on your patient advocacy, billing, and pharmacy teams without requiring additional hires.

Financial assistance matching is time-consuming: tracking thousands of programs, checking eligibility, completing applications, following up on approvals, and managing payments. Our automation handles all of this, freeing your existing staff to focus on patient care rather than paperwork. At partner hospitals, staff previously taxed with managing copay cards, foundation funds, and free drug programs for thousands of patients reported substantial relief after implementation.

Getting Started​

How do we know if Qualify Health is right for our hospital?

If your hospital serves uninsured or underinsured patients, has an oncology department, or is dealing with rising bad debt, you’re likely a strong fit.

Hospitals that benefit most typically have high patient out-of-pocket costs (especially in oncology), growing bad debt, and patient advocacy teams stretched thin by manual financial assistance processes. Non-profit hospitals in states with high Medicaid populations, 340B participation, or exposure to coverage losses from recent Medicaid and ACA changes tend to see the fastest and largest results. Our initial assessment can quickly identify your specific revenue recovery potential.

Can we use Qualify Health reporting to show our board and leadership how we're mitigating payer mix changes such as self-pay increases?

Yes. Our reporting is built for both operational reconciliation and executive-level visibility into how your financial assistance program is offsetting bad debt and uncompensated care.

Hospitals use our reports for two distinct audiences. Operationally, your billing and patient services teams use weekly payment reports to reconcile transactions by patient, drug or service, and funding source (free drug, copay card, foundation, or direct-to-patient assistance), so payments post correctly to the right accounts. At the leadership level, our monthly and quarterly reports surface the metrics boards and executive teams care about: total patients helped, dollars matched by funding category, retroactive recovery from past-due accounts, and trending against prior periods. With Medicaid coverage losses and ACA subsidy expiration accelerating self-pay populations, these reports give CFOs and executive teams a clear, defensible answer to the question, “What are we doing about uncompensated care?” Many of our partners include Qualify Health metrics in their board packets, community benefit reporting, and 340B transparency documentation.

How do we get started?

Schedule a 30-minute assessment. We’ll identify your specific financial assistance gaps and estimate your revenue recovery potential, no commitment required.

During the assessment, we’ll review your current financial assistance processes, identify where revenue is likely being missed, and outline how Qualify Health would work within your specific systems and workflows. There is no obligation and no cost for the assessment. Contact us at info@qualify.health or visit https://qualify.health/book-call/ to schedule.

What does a 30-minute assessment actually involve?

A short discovery conversation about your current financial assistance processes, followed by a back-of-envelope estimate of your revenue recovery potential.

During the assessment, we ask about your current financial assistance workflows, the payer mix and volume in your highest-impact service lines (often oncology and infusion), where your team feels the biggest pain points are today, and any existing tools or vendors in place. Based on that, we can outline how Qualify Health would fit alongside your existing processes and provide an initial estimate of the revenue recovery opportunity. There is no commitment, no cost, and no requirement to share patient data at this stage.

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