Financial Toxicity and Patient Outcomes

Financial Toxicity is the term used to describe the harmful effects that the cost of cancer treatment has on cancer patients. This phenomenon is becoming widely accepted and is recognized as a real risk for those undergoing cancer treatment. Patients who experience financial hardships during their cancer journey are more likely to experience poor clinical outcomes, reduced quality of life, and long-term financial struggles. Those with advanced-stage cancers, undergoing chemotherapy or radiation, and having underlying medical conditions are at the highest risk for Financial Toxicity. Additional risk factors include low income, loss or reduction in work, young age at diagnosis, and being uninsured or underinsured.

In this article, we are going to understand:

  1. The Effects Financial Toxicity Has on the Body
  2. How Finances Influence Medical Decision-Making
  3. Quality of Life During and After the Battle with Cancer
  4. How to Combat Financial Toxicity

The Effects on the Body

Struggling with finances is already a burden for many families in the US. According to an article by the National Cancer Institute, cancer is one of the nation’s most expensive treatments. It is not uncommon for patients and their loved ones to struggle to cover living expenses while undergoing cancer treatment. That stress can significantly affect the body, affecting the musculoskeletal, respiratory, cardiovascular, endocrine, gastrointestinal, nervous, and reproductive systems. Chronic stress can cause long-term damage as the body is constantly on high alert, leading to wear and tear even on an otherwise healthy body. The National Cancer Institute indicates that it’s even more dangerous for cancer patients as stress-induced hormone changes can also impact cancer cells, making them more resistant to treatment and even causing them to spread.

Finances Impacting Medical Decisions

When coping with the financial burden of cancer treatment, patients often must make difficult choices as they struggle to balance the cost of daily living with the added expense of treatment. This strain can result in them canceling appointments or delaying treatment to make ends meet. Sometimes, patients even resort to halving their meds or skipping doses to prolong their prescription and save some money. The problem is that these measures might ease the budget, but they also reduce the effectiveness of treatment and outcomes.

Quality of Life During the Fight and Long After

Struggling with financial toxicity while fighting cancer can significantly impact your quality of life, both during and after treatment. Many patients deplete their savings, including retirement funds, and cut back on leisure activities and expenses like food and clothing to save money. Unfortunately, prolonged treatment and the possibility of cancer recurrence mean that the cost of care extends far beyond chemotherapy and radiation. Research shows that cancer survivors are more than twice as likely as those without cancer to file for bankruptcy. It’s essential to address the financial challenges of cancer treatment so that patients can focus on what matters – their health and healing.

How to Combat Financial Toxicity

Protecting yourself from financial hardships caused by illness is essential. More than simply having health insurance is required – you must ensure adequate coverage. This means understanding the expenses not covered by your insurance and setting aside money to cover these costs, including your deductibles and out-of-pocket maximums. If you can’t afford these costs, you’re likely underinsured. If you’re employed, ensure you understand the benefits your employer offers. Learn about open enrollment periods, supplemental insurance options, employee assistance programs, and policies regarding leave and time off. When you visit your healthcare provider, ask about the cost of treatments and discuss your options with your finances in mind. If you need financial assistance, many oncology practices offer services for this, so don’t hesitate to make an appointment to ask for help.

Resources that Can Help

Adequate health insurance is ideal, but not everyone can afford it. That’s where Qualify Health comes in. The organization works with hospital systems, cancer treatment centers, specialty pharmacies, and physician offices to help uninsured and underinsured patients afford needed treatment. Qualify Health specializes in patient financial advocacy, which involves reducing the financial burden on patients with chronic and life-changing illnesses. By finding funds for out-of-pocket healthcare expenses like co-pays, premiums, and even transportation, Qualify Health works alongside healthcare providers to get patients the care they need while easing the financial burden.

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Financial toxicity caused by cancer treatment can devastate the patient’s physical and emotional well-being. It is crucial to understand how finances influence medical decision-making and what resources are available to help manage the financial burden of this serious illness. By taking proactive steps such as understanding one’s health insurance coverage, asking providers about costs upfront, and seeking out organizations like Qualify Health that specialize in helping uninsured or underinsured patients afford treatments, individuals can reduce their risk for financial hardship associated with cancer care. Ultimately, these measures will help ease the stress and enable patients to focus more fully on their health and healing journey.

For more information about Patient Financial Advocacy Solutions, contact Qualify Health at (888)770-7191.

What are Social Determinants of Health and How Can We Make a Difference?

Did you know that your environment affects your health and well-being? Social determinants of health (SDOH) are the conditions where we live, learn, work, and age. Access to housing, education, employment, food, transportation, and social services are all factors that impact our health outcomes and risks. SDOH also includes resources and services that prevent, diagnose, treat, and manage diseases. By recognizing these social factors, we can take steps to address the root causes of health issues in our nation. So let’s start by understanding SDOH to improve our health and quality of life! 

The five domains of SDOH:

1. Economic Stability

2. Education Access and Quality

3. Health Care Access and Quality

4. Neighborhood and Built Environment

5. Social and Community Context

This article will focus on understanding issues with Health Care Access and Quality.

The Uninsured Population

Did you know about 1 in 10 people in the United States don’t have health insurance? A consequence of this is that the uninsured only seek care when they have a problem. As such, this population rarely receives early detection screenings by primary care providers. Without these screenings, they face late diagnosis and poorer health outcomes. In addition, as patients become ‘sicker,’ they become an increased burden on health systems.

The Impact on Health Systems

Due to the inability to pay providers, the uninsured will utilize the hospital when seeking medical treatment. Hospitals are obligated to treat patients, whether or not they have insurance. Therefore, they must care for patients without insurance regardless of the associated costs. This issue negatively impacts the hospital and the patient: The hospital is rarely paid. Instead, they write the patient’s expenses to bad debt and send them to collections – thereby exacerbating the cycle of unaffordability.

The Underinsured Population

As healthcare costs continue to soar, many companies are turning to high-deductible plans to save money. Unfortunately, this means employees are burdened with higher out-of-pocket expenses for medical services. Those with high deductibles and high out-of-pocket costs relative to their incomes are known as underinsured. Some individuals may delay or even skip necessary treatment due to cost concerns. One survey found that 25% of Americans have missed medical appointments or put off care because of financial worries. For those with chronic conditions, the added expense of medications can easily reach thousands of dollars per year, causing undue strain on families and the healthcare system.

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Transportation Issues Limit Access

Getting to the doctor can be challenging, especially if you live in a rural or low-income area. Some people miss appointments and miss out on crucial healthcare because they don’t have reliable transportation. This issue can be dangerous – not getting the proper treatment quickly can lead to more significant problems. But transportation isn’t just important for doctor visits. It can be hard to get healthy food or exercise if you can’t get around. That’s why better public transportation is vital to helping everyone get the healthcare they need and deserve.

Quality Resources that Can Help

Everyone deserves quality healthcare, but unfortunately, not everyone can afford it. That’s where Qualify Health comes in. The organization works with hospital systems, cancer treatment centers, specialty pharmacies, and physician offices to help uninsured and underinsured patients afford needed treatment.

The focus is on patient financial advocacy, which involves reducing the financial burden on patients with chronic and life-changing illnesses. By finding funds for out-of-pocket healthcare expenses like co-pays, premiums, and even transportation, Qualify Health ensures patients get the care they need without worrying about the cost.

For more information about Patient Financial Advocacy Solutions, contact Qualify Health at (888)770-7191.

How to wrap your head around health disparities, health equity, and social determinants of health!

How to wrap your head around health disparities, health equity, and social determinants of health!

The latest report from the nonprofit Commonwealth Fund confirms what we already knew: that the United States is leading the world in people who suffer from multiple chronic conditions and obesity. This distinction means American citizens have almost double the obesity rates compared to the average of the other 36 countries in the Organisation for Economic Co-operation and Development (OECD). The gravity of this alarming news should not be overlooked. Instead, it should inspire us to take immediate action to address the current state of our nation’s health. But you may wonder, “What can we do to drive change?”

The Healthy People 2030 Initiative

In 1979, the HHS and Office of Disease Prevention started a mission to make us all healthier with the “Healthy People” initiative. For over 40 years, they have created strategic plans to make this a reality. In this latest iteration, they’ve focused on five areas to develop a framework for healthier living. You might’ve heard these buzzwords thrown around by healthcare executives, the government, and the media, but do you really know what they mean? So, let’s dive in and get a clear understanding.

The Framework:

  1. Health Disparities
  2. Health Equity
  3. Health Literacy
  4. Well-being
  5. Social Determinants of Health
  6. Health Disparities

Health disparities are not only mere differences in health among individuals but also health gaps linked with social, economic, and environmental factors. They can relate to gender, age, mental or physical disability, sexual orientation, gender identity, geographic location, or other characteristics associated with discrimination or exclusion. The goal is to reduce disparities between different demographics (using the ideas discussed below), improving our nation’s overall health.

  1. Health Equity

Health equity is achieved when all patients have access to resources needed for optimal health. A person’s race, ethnicity, gender identity, or any other demographic factor should not influence a person’s health. This includes access to quality healthcare services and social support systems such as education and employment opportunities. By addressing access to quality healthcare, employment opportunities, and education at a systemic level, better overall health outcomes for all are attainable.

Learn How Qualify Health Can Help

  1. Health Literacy

Health literacy is more than just understanding medical jargon- it’s about comprehending and applying that information to make informed decisions for our well-being. To achieve this, health organizations must offer resources that are user-friendly, easily accessible, and doable. By doing so, people can make empowered choices related to prevention, diagnosis, treatment, and ongoing care, leading to a healthier population overall. In addition, prioritizing health literacy puts the power of information in everyone’s hands.

  1. Well-being

Well-being is about the perception of one’s overall life satisfaction. It can be different for everyone, but the goal is to lead healthy and fulfilled lives across the lifespan. Achieving overall mental and physical health, having a purpose in life, feeling secure, bouncing back from stressors when needed, and garnering access to vital healthcare resources all play a role in well-being. It combines subjective elements, such as satisfaction with life, and tangible components, like income or education. Focusing on well-being across all demographics helps build healthier communities and improves the quality of living for everyone.

  1. Social Determinants of Health

The conditions in which we live affect our health and well-being in more ways than we might realize. These are known as social determinants of health (SDOH), encompassing many factors that can impact our lives. For example, having safe housing and transportation, living in a clean environment, and having access to healthy food and exercise opportunities can all positively affect our health. Conversely, experiencing discrimination and violence or living in polluted areas can negatively affect our well-being. In addition, education, job opportunities, and income are essential factors in determining our overall quality of life. By understanding and addressing these social determinants, we can work to create healthier and more equitable communities for all.


We cannot ignore the nation’s health status, and there are steps we can take to move forward. Educating ourselves about Health Disparities, Health Equity, and Social Determinants of Health will help us understand what improvements need to be made in our communities today. There are various initiatives underway to address these issues. 

Qualify Health is an organization that prides itself in promoting health equity and impacting health disparities. By partnering with hospital systems, cancer treatment centers, specialty pharmacies, and physician offices, Qualify Health provides innovative patient financial advocacy solutions to minimize the financial burden on patients with chronic and life-changing illnesses. Patient Financial Advocacy solutions, like those provided through Qualify Health, are essential to improving all people’s overall health and well-being, regardless of socioeconomic status.

By implementing changes, we can create healthier communities and improve the quality of life for everyone.

For more information about Patient Financial Advocacy Solutions, contact Qualify Health at (888)770-7191.

An Indianapolis Health System’s $60 Million Health Equity Initiative

Health equity has become a key focus in healthcare, and it’s making headlines and hospitals across the country are being tasked with playing a critical role in the health equity movement. As anchors in their communities, hospitals can harness their economic power and community linkages to shape change.

The CDC has defined ‘Health Equity’ as “The state in which everyone has a fair and just opportunity to attain their highest level of health” and has highlighted that the following societal efforts need to occur

  1. Address historical and contemporary injustices;
  2. Overcome economic, social, and other obstacles to health and health care; and
  3. Eliminate preventable health disparities

The one area that healthcare organizations can make the fastest and most significant impact is by addressing #2: Overcoming economic, social, and other obstacles to health and health care; which we will be addressing in this blog through three avenues that are at a hospitals fingertips.

  1. Food Insecurity 

Food insecurity is a major issue for many individuals and families in the US, and it has been estimated that more than 37 million Americans are food insecure. This means that they do not have reliable access to enough affordable, nutritious food to lead an active, healthy lifestyle. Food insecurity can lead to health issues such as obesity, diabetes, heart disease, and even mental health conditions due to the lack of proper nutrition.

  1. Transportation

Another significant barrier to care for many individuals is transportation, especially those in need of medical care. The geriatric population and those suffering from chronic illness are particularly vulnerable to this issue due to their limited mobility and financial resources. Without access to reliable transportation, these individuals may have difficulty accessing the necessary health services they need due to time or distance constraints. This can lead to delayed diagnosis or treatment, resulting in poorer health outcomes overall. 

  1. Housing Instability

An estimated 18 million Americans, face issues with housing instability. Housing insecurity can lead to poor health outcomes due to inadequate living conditions, lack of access to medical care, and increased stress levels caused by financial difficulty.  

What Eskenazi Health is Doing to Overcome Health Disparities in their Community 

Eskenazi Health in Indianapolis is taking diligent steps in its fight against health inequity through its latest initiative. The multifaceted approach seeks to reduce barriers for those most vulnerable and at risk for poor health outcomes due to social determinants of health such as food insecurity, transportation, and housing instability. Eskenzai Health Foundation received $36 million towards the $60 million Health Equity Campaign. Through this campaign, the hospital system intends to make strides toward creating a stronger, healthier community by addressing these issues head-on.

Eskenazi Health’s health equity initiative is an example of how communities can proactively address healthcare disparities. This campaign will not only reduce barriers for members of the community but also raise awareness of the health inequities present in our society and work towards a more equitable healthcare system. Eskenazi Health is actively working to ensure those most at risk are provided with access to necessary resources for a healthy lifestyle. By continuing its efforts, Eskenazi Health is well on its way to creating a healthier and more equitable community for all. 

How Qualify Health Can Help 

Sourcing funds for managing long-term or chronic illness is a key element needed to reduce the financial burden placed on patients. Qualify Health’s Patient Financial Advocacy solution makes it easy for hospitals to help their patients obtain financial assistance such as co-pay, premium, transportation assistance, and more. This financial assistance enables patients to pay for the treatment they need as well as living expenses instead of having to choose.

For more information about Patient Financial Advocacy Solutions, contact Qualify Health at (888)770-7191.

The Complexity of Managing Cancer Copay Programs

Cancer copayment assistance programs can be complex to manage, with various rules and regulations that must be followed. Cancer Center Executives must ensure that these programs are run efficiently and effectively in order to help patients afford their treatment and ensure that your revenue is maximized. In this blog post, we’ll explore the challenges of managing cancer copay programs and offer some tips on how to overcome them. Read on to learn more!

The first challenge of managing cancer copay programs is making sure that all of the necessary funds are available to patients. Many patients cannot afford their treatments and need assistance in order to make them financially possible. To ensure that these funds are available, Cancer Center staff must be organized and proactive when it comes to tracking eligibility, submitting necessary documentation, following program rules, and getting appropriate signatures.

Another challenge of managing cancer copay programs is staying up-to-date with the ever-changing regulations. Since laws and regulations are continuously being updated or changed, hospitals must remain aware of any changes in order to ensure that they are compliant with local and federal guidelines. Staying on top of these guidelines can be time-consuming, but it is essential for running a successful program. One of the biggest examples here is ensuring that your federally insured patients realize that they are unfortunately restricted from these programs and therefore not able to benefit the same way as commercially insured patients.

Finally, managing cancer copay programs involves a lot of paperwork and data entry. Hospitals must keep detailed records of application status, bills that have been submitted, checks that have been received and copay cards that have been loaded in order to ensure accuracy and compliance. This can be tedious work, but it is necessary for running an efficient program.

Fortunately, there are some tips that Cancer Center Executives can use to make managing cancer copay programs easier. First, hospitals should partner with an outside organization that can help them manage their program more effectively. These organizations have the experience and expertise needed to ensure that everything is done correctly and in compliance with regulations. Organizations like Qualify Health provide a fully managed service that combines a human layer of service and intelligence to streamline the process of collecting and entering data. They then continue to ensure that all bills are submitted on behalf of the patient and the funds are sent to the hospital.

The key to successfully managing cancer copay programs is staying organized and proactive in ensuring all patients are signed up and accessing the care they need. With the right tools and strategies, hospitals can ensure that their programs are running smoothly and helping as many patients as possible.

Remember, managing cancer copay programs doesn’t have to be a struggle. By utilizing the right resources and staying organized, Cancer Center Executives can ensure that their program is efficient and compliant with all regulations. If you need help managing your program, contact us today for more information. We’re here to help!

Delays in care due to errors with Prior Authorizations

Prior authorizations are essential to make sure that a patient’s insurance carrier is going to pay for their treatment. The greatest doctor with the best diagnosis and treatment protocol is ineffective if the patient cannot afford it or if their insurance will not cover it due to a lack of authorization. What causes prior authorizations to be denied, slip through the cracks, or otherwise be left unfulfilled? Here is a case regarding a real patient with their hepatitis C medication.

Patient X had been confirmed to have Hepatitis C and the drug ordered by the prescriber required a prior authorization. The doctor who made the diagnosis recommended a protocol involving Epclusa which, through most insurance carriers, can demand quite a few clinical notes to support the administration of the medication: a check for cirrhosis, a concurrent infection of HBV (hepatitis B), whether or not the patient has tried and failed a similar medication before—just to name a few!

The pharmacy that was to dispense the medication noticed that the drug did require prior authorization (most prior authorizations for outpatient prescriptions start in the pharmacy!) A request was sent to the office and an initial authorization request was sent to the insurer. However, a follow-up fax was sent back with the requesting of additional clinical information – a scan that wasn’t performed yet on the patient’s liver. The staff made an appointment for the patient to come in and the scan was performed. Afterwards, though, the scan was never sent to the insurer and, thusly, the authorization was denied. A follow-up authorization was initiated and, as what happens after most denials, it was immediately denied as the initial authorization was and now an appeal is required.

An appeal is when the office staff, patient, or advocate of the patient claims that the decision to deny was in error and to have the determination overturned. This was strange to the staff because all the criteria matched, they were just trying to send the required information that was asked of them. Part of the prior authorization process is to follow the flow: even though the office staff did everything within their power to advocate for the patient, the idea of an appeal for a medication that fit the indication did not quite make sense, it should be approved!

After three months of back and forth with the insurer, Qualify Health was requested for assistance, able to intervene, find out the proper format for an appeal, accrue and compile the necessary clinical information to support the use of the drug, have a signed attestation from the prescriber that the information provided is verified, and submitted through the proper channels with an URGENT expedite for a faster turn-around! After Qualify’s assistance, the drug was approved for the patient within twenty-four hours with a gracious and appreciative patient that was finally going to get the treatment that they needed.

Ultimately, prior authorizations are, and should be, part of the clinical processes in any office. There should always be a flow, a delegate for duty, and organization for the myriad processes that every insurance carrier requires based on the drug, treatment protocol, or inpatient administration because anything beyond immediately is too long for a patient that requires treatment.

How Financial Advocacy Can Help to Reduce Health Equity Disparities

Blog Introduction: Health equity disparities are pervasive and have significant implications on the health and well-being of individuals. These disparities have been attributed to a variety of factors, including financial inequity, lack of access to quality health care, and inadequate public policies that fail to address the needs of marginalized communities. Financial advocacy is a tool that can be used to help reduce these disparities by ensuring equitable access to healthcare services. In this blog post, we will discuss how financial advocacy can help bridge the gap between those who need healthcare services and those who are able to receive them.

What is Financial Advocacy? 

Financial advocacy is an approach that focuses on increasing access to healthcare services for those who cannot afford them or do not have insurance coverage. This includes providing resources such as scholarships, grants, direct subsidies, or other forms of financial assistance that can help patients pay for medical expenses. It may also include helping patients navigate the complex world of insurance coverage so they can receive the care they need without going into debt.

Benefits of Financial Advocacy

Financial advocacy has many benefits for both patients and providers alike. For patients, it increases access to care by reducing out-of-pocket costs and making it easier for them to get the care they need without having to worry about how they will pay for it. For providers, it ensures that all patients are treated equitably and that no one is denied care due to their inability to pay. It also helps providers ensure higher levels of patient satisfaction since their patients will be more likely to complete recommended treatments if they don’t have to worry about paying for them out-of-pocket. Furthermore, financial advocacy has been shown to improve overall health outcomes by reducing delays in treatment due to cost considerations or lack of insurance coverage. This means that by investing in financial advocacy programs, providers can ensure better health outcomes while also improving patient satisfaction rates.   

In Summary, Financial advocacy is an important tool in helping reduce health equity disparitiesBy searching for ways that providers can help source financial assistance directly related to medical expenses, you help to ensure equitable access to healthcare services regardless of a person’s income level or insurance coverage status. This not only improves patient satisfaction but also leads directly leads improved overall health outcomes due reduced delays in treatment caused by cost considerations or lack of insurance coverage. All healthcare providers and hospital executives should look at ways in which their organizations can implement programs to maximize the sourcing of financial advocacy as part of their efforts towards promoting equity in healthcare services across all communities affected by these disparities . 

How Financial Advocacy Can Help Solve Health Equity Disparities  

Blog Introduction: Poor health outcomes due to disparities in healthcare, often based on socioeconomic factors like race and income, can be seen all over the world. These differences in outcomes are due to lack of access to preventive services, diagnosis and treatment, as well as social determinants such as education and housing. To address this issue, financial advocacy has emerged as a potential solution to increase access to quality care.  

What is Financial Advocacy?  

Financial advocacy is a form of patient navigation that links patients with resources and programs that can help them pay for their medical expenses. It also helps individuals understand their rights under their insurance coverage and provides support when they are trying to resolve payment issues with providers or insurance companies. By connecting patients with resources like financial assistance programs and charities, financial advocates provide an additional layer of support for those who need it most.  

The Benefits of Financial Advocacy for Health Equity Initiatives  

The impact of health equity initiatives can be greatly increased by utilizing financial advocacy. For example, many people put off seeking medical attention due to fear of high costs. Financial advocates can help alleviate this fear by linking patients to available resources that can help cover the cost of care. This not only increases access to care but also helps reduce disparities in health outcomes among different socioeconomic groups.  Additionally, financial advocates can help ensure that all individuals receive the same level of care regardless of their ability to pay. By connecting patients with available resources such as charitable funds or sliding-scale payments, financial advocates are able to provide equal access to quality healthcare regardless of individual income levels or insurance status.   


In conclusion, financial advocacy is an important tool in solving health equity disparities. By providing additional support for those who need it most, financial advocates play an integral role in ensuring that everyone has access to the same level of care regardless of income level or insurance status. By working together with healthcare providers and other stakeholders, we can make sure that everyone has the opportunity to lead a healthy life free from economic hardship or discrimination due to socioeconomic status.

How to Optimize Prior Authorization: Tips and Tricks for Providers

MT: Tips & Tricks for Physicians to Optimize Prior Authorization

MD: Prior authorization burdens physicians and impacts care. Use PMS and EMR systems to optimize prior authorization, manage denials, and eliminate disconnect.


The wait for a prior authorization to be approved can cause patient anxiety and limit their care. However, from the providers point of view, the main focus on the prior authorization is getting it approved so that you can be reimbursed

Managing the patients emotional response to the prior authorization waiting gain can be less stressful if you include a strategy to work with the patient, and communicate with them, setting clear expectations. Implementing these conversations as part of your workflow and optimizing your prior authorization process with a much more streamlined process can result in two outcomes:

  1. Lowered patient anxiety
  2. Faster time to treatment
  3. Improved financial and operational efficiency for your practice

Tips to Optimize Prior Authorization

The process of obtaining prior authorization involves numerous manual steps and parties, resulting in errors. Lengthy medical reviews necessitated by prior authorization may delay care and create confusion for physicians and patients.

You can reduce the time required to treat a patient by automating the entire prior authorization procedure as soon as possible in the revenue cycle. It reduces the likelihood of errors occurring and the quantity of labor that must be performed manually.

Let’s find out the useful tricks to optimize prior authorization.

Utilize Your Electronic Medical Records (EMR) Systems

Start by maximizing the huge investment that almost all providers have made in their EMR’s.. By better utilizing your reporting functionality, you will open up the ability to better track your prior authorizations and where they are in the chain of: Submit / Approved / Denied / Appeal. These reports must, at the minimum, show the date that the authorization is needed and where it is in the process. However, having the report will be of no use, unless you have a set of eyes on it each day, and ensuring that follow ups are occurring, as needed in order to ensure the PA is complete before the patients appointment.

Work on Denial Management

Denial are a burden, but they should also be considered as a learning opportunity. Understanding the cause of your denials will help you prevent them in the future and ensure that future prior authorizations include the necessary documentation to prevent a reoccurrence. Utilizing a reporting system that gives you insight into what transpired will allow you to identify patterns. The next step is collaborating with internal and external expertise that will allow you to create a system that can capture the necessary information in the authorization submission process.

Know and Track your Policies

Most payers put their coverage rules online, they are transparent and accessible. It is important that you continue to monitor revisions and yet keep old policies. The importance of keeping historical policies on record mean that you have access to it, in cases of the need to If a payer wishes to appeal a 2021 rejection, they must use a 2021 policy, but they typically don’t know which one. However, by maintaining historical emails, bulletins, and other insurance-related documents, you have the ability to review them when fighting a denial.

Outsource Prior Authorization to Experts

Given the time and expertise needed for successful prior authorizations, experts are needed. However, because this is a ‘cost center’ practices are induced to assign their lowest cost and lest experienced employee to this role. It will take longer and may lead to errors. In many cases, making the choice or using an outsourced service provider will  save your medical facility money over time, and ease the stress of the prior authorization process. Further, as prior authorization specialists are constantly focused on ensuring that they stay updated on new policies and regulations, it ensures that you are always up to date with the documentation and information that you need to submit.

Four Tactics to Manage Patient Healthcare Costs

Medical Bills


Imagine if America’s government had an extra $1.3 trillion each year? Imagine how many poor and homeless people you could help, how much infrastructure could be improved, and how much money could be poured into educational and social care programs. According to government spending reports, the country could reach this type of saving it was to just bring down healthcare spending to that of comparable countries.

If we want healthcare spending and quality in America to be on par with the rest of the industrialized world, we need a fundamental shift in our approach to healthcare.

Below, we outline four distinct approaches exist for kickstarting this endeavor.

  1. Payment Plans
  2. Mail Order Pharmacy
  3. Technology to drive Continuum Care
  4. Helping patients understand Health Insurance Jargon

Patient Payment Plans

When patients have difficulty finding the means to pay for their health care, physicians are left to shoulder the financial burden. Their response is usually to send the outstanding monies to a collections agency without first trying Payment Plans.  If Providers became more familiar with employing payment plans to assist patients they would bring improved patient satisfaction and improved revenue and payment metrics! As out of pocket costs continue to rise for patients, payment plans will become an essential method of assisting them in paying for their treatment, over time, and in smaller quantities.  

Mail Order Pharmacy

The primary function of a “mail-order pharmacy” is to mail prescription medications to patients. Patients who fill their prescriptions through mail-order pharmacies, which are usually owned, or managed through their health or prescription benefit plan reduces the patient’s out of pocket costs, as the insurance plan offers to cover some of the copay costs as an incentive. Patients who use mail-order pharmacies are also more likely to be compliant, as their medications are delivered to their homes and usually in 90-day supplies.  So in addition to being cheaper, it is also more convenient and they have multiple months before they need to refill.

Technology to drive Continuum Care

Technology can provide patients with more options, such as receiving care in a less stressful environment. Since the Covid pandemic, patients are becoming increasingly comfortable with the use of telehealth and mobile apps to access care. These technology options meant that they  can avoid visiting out-of-network medical facilities, which place an increased cost burden on the patient.. Further, using technology can also promote patient compliance and make scheduling more efficient, reduce no-shows and more efficiently manage their providers scheduling. All of these factors allow health systems to save money over time.

Helping Patients Understand Health Insurance Jargon

It is crucial that patients understand key aspects of their health insurance. Words like “Deductible”, “Max out of Pocket”, “Copay”, “In-Network”, “Out-of-Network” are a jungle of insurance that much of the country doesn’t understand.  Healthcare advocates can help patients with this terminology so that they can learn that timing of their expenses can make a big difference to their overall costs (for example, if they have hit their deductible, then make sure any expensive procedures occur before the end of the year).


The cost of health care is out of control for most Americans, and when patients can’t afford their care, they either don’t receive it – causing major impacts in the care continuum and hurting hospital’s value-based care metrics, or become unable to pay their bills, impacting a provider’s revenue and their credit scores when they are sent to collectsion.

Implementing technology that helps patients adhere to their treatment plans is one option to save patient costs and improve efficiency. Payment plans are also vital for assisting patients in paying for therapy. It is also essential to communicate health coverage and health insurance jargon with patients to help them manage healthcare costs. To learn more about helping patients manage healthcare costs, get in touch with Qualify Health, we are dedicated to improving healthcare finances.

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