Arlington Health's five central Ohio locations are just one of hundreds of healthcare providers throughout the country that are struggling as the nation's largest health insurance payment system remains down due to a cyberattack.
Change Healthcare, owned by the nation's largest health insurer, UnitedHealth Group, was hit with a ransomware attack two weeks ago, crippling its systems and keeping the company from processing insurance claims. Arlington Health's Chief Operating Officer Molly Fulton said the situation is dire for medium to small providers like hers and some may be at risk of closing in the coming weeks unless something is done.
Arlington Health operates five urgent care locations in central and southwest Ohio in Bexley, Upper Arlington, Worthington, Delaware and Washington Courthouse. The company, like so many others across the U.S., uses Change Healthcare as a middleman to verify and securely process health insurance payments and patient information from hundreds of patients who visit them in a week.
Fulton said the system being down cripples their ability to receive payments from UnitedHealthcare that normally arrive in a couple weeks after the patient receives care. That means a large chunk of revenue for these providers is not arriving on time.
Fulton said her company can weather this storm for now and aid has been offered by UnitedHealth, but that clearly isn't enough. The U.S. Department of Health and Human Services (HHS) is considering stepping in to help, but nothing is final yet, leaving some providers in danger of closing.
"What Change Healthcare has done... it's not even going to break the surface. And there has to be something else done to provide some assistance to providers, or you're going to see a lot of people go out of business," Fulton warned.
Change Healthcare said in a statement they were a victim of a cybercrime threat actor who identified themself as ALPHV/Blackcat two weeks ago. The system is still down, but the company said based on its ongoing investigation, there is no indication that its subsidiary Optum, UnitedHealthcare and UnitedHealth Group systems have been affected by this issue.
Change Healthcare is a digital clearinghouse that connects the healthcare providers to insurers and is estimated to process one in three patient records in the country and 50% of all medical claims.
Reuters reported Tuesday the company allegedly attempted to pay the hackers $22 million as a ransom to free up the sites.
The HHS announced Tuesday it would take steps to try to alleviate the financial pressures on some of those affected, mainly hospitals and doctors who receive Medicare reimbursements, but lawmakers and other powerful hospital industry executives and patient groups are pressuring the government for more relief.
Fulton said she believes the federal government is going to have to step in and do some sort of bailout or offer more assistance to providers.
Ohio Hospitals Association Director of Media Relations John Palmer said elsewhere in Ohio, providers they represent as large as Cleveland Clinic and smaller hospitals in more rural communities are also being impacted. He said the system being down is extremely detrimental to all hospitals who use Change Healthcare, but ultimately hurts smaller providers even more.
"When that's all disrupted. You know, that also impacts hospitals' abilities to receive payment and then ultimately that impacts their abilities to be able to pay for facilities, pay for labor, pay for supplies and equipment," Palmer said.
Palmer's organization represents about 252 hospitals throughout the state, ranging from critical access hospitals to small rural hospitals to academic center facilities. OHA also represents 15 health systems. He said all of them use different vendors and some use multiple vendors and may not be as impacted as places like Arlington Health that only use Change Healthcare.
Fulton said Arlington Health has switched to a different clearing house, but did not want to leave Change Healthcare.
"We did not originally want to do that. We were going to stick it out with Change Healthcare, because we were at that time confident that they would eventually have a resolution to this issue," Fulton said.
She said they lost that confidence, but switching to a new vendor is not like flipping a switch. She said it takes at least a 10-to-12 day processing time to get that up and running. So even with that switch, Arlington Health is looking at another 10 to 12 days at a minimum of not being able to submit claims and not being able to get adjudication back from the insurance companies.
Fulton said Arlington Health has a healthy financial background and has the reserves to make it through that without interrupting service or it impacting employee's salaries. But, she said other smaller providers or those with less healthy financials may not be so lucky.
"You can imagine that other systems that might be smaller, you know, the PCPs office in a rural health community or the OB/GYNs office in a rural health community that doesn't have the benefit of having a strong financial background or a strong financial footing. You know, these providers are having to dip into their own personal savings to just keep their businesses afloat, and it's just not going to be feasible for long term," Fulton said.
