As the fallout from a major health care industry breach enters its third week, desperate people throughout the nation are forced to decide whether to pay for necessary prescriptions out of pocket or skip them completely.
On February 21, Change Healthcare, a little-known but crucial UnitedHealth Group business, discovered the assault. Since then, patients, physicians’ offices, and pharmacies have said that widespread disruptions in systems often utilized for insurance claim processing and medical billing have completely disrupted their lives and livelihoods.
Particularly, issues with copay assistance and discount card processing at pharmacies have brought attention to important weaknesses in a system that is essential to people’s daily existence.
The 54-year-old Ronda Miller stated that her husband, who has Type 2 diabetes and congestive heart failure, depends on a discount card to pay for his insulin. However, on February 22, the card was declined when she attempted to pick up his prescription at her drugstore in Deadwood, South Dakota. The drugs would cost hundreds of dollars without it.
Miller said, “People with diabetes, whether Type 1 or Type 2, will die without insulin.”
The technology of Change Healthcare is used in business dealings across the board, not only with United Healthcare insurance. According to the corporation, it processes 15 billion transactions annually, including $1.5 trillion in health claims. Change said on its website that the attack had an impact on 21 different areas of its operations, many of which providers utilize to process patients’ insurance eligibility, be paid by insurers, and get reimbursed.
“Everything that needs to work with health plans—a pharmacy, a facility, or an office—has been interfered with,” said American Medical Association President Dr. Jesse Ehrenfeld. “That has broad ramifications, regardless of whether you depend on a pharmaceutical company’s rebate program, are on regular, standard medication, or are just attempting to obtain authorization for routine elective surgery.”
In a statement, UnitedHealth Group said that the services would “remain offline until we are certain we can turn them back on safely” and that it had taken “immediate action to disconnect Change Healthcare’s systems to prevent further impact.”
The business said on Tuesday that, as early as this Thursday, a new network that links pharmacies and benefit administrators may be live.
The largest impact in her community, according to Laura Lester, owner of Marion Family Pharmacy in Marion, Virginia, has been on patients who are unable to pay for their prescription drugs without copay assistance cards.
“People are abstaining from antipsychotics, diabetes medications, and ADHD medications,” the spokesperson said.
“We encountered a woman yesterday who was unable to use her copay card and had to pay $1,100 out of pocket,” she said. She indicated that the patient’s irritable bowel condition required the prescription.
Patients who choose not to seek copay help have nonetheless encountered several difficulties. At Florida Cancer Specialists & Research Institute, Donna Hamlet, 73, is a patient with breast cancer. She takes a medicine called IBRANCE, which would cost her almost $16,000 a month if she didn’t have insurance. However, on February 23, she said, a pharmacy informed her that, due to the hack, it was unable to process her insurance-covered prescription.
Hamlet said, “The cancer would fill up my body, and I guess I would die,” in the absence of the medication.#Patients
She had to make many phone calls for four or five days before OptumRx, a pharmacy benefit manager for UnitedHealth Group, could fill her medication.
The CEO of the Florida facility that is treating Hamlet, Nathan Walcker, calculates that the hack has caused billing delays that have impacted $350 million in practice charges.
Although many insurance companies demand prior authorizations for cancer treatments, which can cost up to $100,000 each, Walcker said he is particularly concerned about patients who are unable to have them completed.
“As of right now, we are unable to even determine whether we have a prior authorization for a new patient,” he said.#Patients
During the outage, the Centers for Medicare and Medicaid Services on Tuesday urged Medicare and Medicaid programs to eliminate or loosen previous authorizations and to think about providing advance financing to healthcare providers. According to CMS, hospitals may seek faster payments, and Medicare providers who are having trouble submitting claims can deliver paper copies and could be qualified for an exemption or an extension.#Patients
According to UnitedHealth Group, because of interim repairs or the resumption of system operations, around 90% of claims were “flowing uninterrupted” as of Tuesday, with pharmacy claims “flowing at near-normal levels.”
The corporation has pushed for healthcare providers to use the Optum system in order to speed up the process of filing claims and being paid. According to the firm, “the majority of the coupon volume” handled by Change Healthcare should be addressed by the new network connection that it anticipates on Thursday.
Medical offices may also apply for short-term loans from Optum; however, suppliers claim these are inadequate.#Patients
In Exton, Pennsylvania, Dr. Christine Meyer runs an internal medicine clinic. She alleges that her office files up to $600,000 in claims each month, yet all she is awarded is $4,000.
Meyer described the little offer as “an emotional slap in the face” given the abrupt cessation in earnings.#Patients
She added that her team prints around 1,000 paper claims and FedExs them to Medicare. She also manually submits certain claims to insurance websites.
“My next task is to reduce costs, stop purchasing supplies and vaccines, cut back on staff and hours, and, worst-case scenario, simply close our doors,” Meyer said.
Physicians, pharmacists, and industry insiders claim that the attack has revealed significant weaknesses in the healthcare business, especially in light of Change Healthcare’s hegemony.#Patients
“How come you’re leaving the owners of small pharmacies to try to find a solution when your system has this major leak almost two weeks later?” questioned Skippack Pharmacy’s owner, Dr. Mayank Amin, located in Skippack, Pennsylvania.
Amin said that he and his team had called insurance companies for hours on end to manually determine each patient’s eligibility. He stated that he had been up until two in the morning every night due to work. In order to provide a patient with some free samples of a blood thinner, he even has plans to pick them up at a nearby doctor’s office.
What can I expect from this? “No financial gain, but the satisfaction of knowing you can support someone in need,” he said.
According to Ronda Miller, her husband’s doctor offered a sample, and her South Dakota drugstore gave him a free box of his diabetic medicine for the time being. She said, however, that for families like her own, the interruption has amounted to “playing with people’s lives.”#Patients
The hacker “represented itself to us as ALPHV/Blackcat,” according to Change Healthcare. Alphv was a part of the $100 million assault on MGM Resorts that occurred last year. A bunch of cybercriminals who speak Russian created and maintain it.
According to Chainalysis, a firm that records bitcoin payments, ransomware victims received a record $1 billion in extortion payments last year.#Patients
When asked whether UnitedHealthcare paid a ransom, the company remained silent. However, specialists from the bitcoin analytics firm Tenable and the cybersecurity firm Recorded Future pointed to a bitcoin wallet that was paid more than $22 million on Friday. According to the corporations, NBC News was able to access the wallet that belonged to Alphabet. The news was initially reported by Wired.
Since then, the money has been distributed, mostly in $3.2 million chunks that the two firms haven’t been able to completely track down. The website for Alphv on the dark web indicates that it is no longer in use.#Patients
If UnitedHealth did pay a ransom, cybersecurity expert and CyberSheath CEO Eric Noonan said that “it’s a terrible precedent, because what it now does is say this is a viable market.”
Because Change Healthcare operates vital infrastructure and the assault had obvious repercussions, Noonan described the company as “a very attractive target.”
According to Noonan, UnitedHealth must investigate whether there has been a violation of patient privacy. Only that its personnel are “actively engaged and working to understand the impact” has been said by the corporation thus far.
Noonan also demanded that all key infrastructure sectors, including the healthcare industry, be subject to the mandatory minimum cybersecurity regulations set by the federal government. #Patients
“I believe that Americans are not very protected in this sense because they depend on businesses to deploy appropriate cybersecurity measures, which are generally not being implemented,” he said.
SOURCE: NBC NEWS
