For the last three weeks, a supposed cyberattack on Change Healthcare, a unit of the United Healthcare & Optum organization, has dramatically disrupted the business of health care providers across the United States.
Medicare and all commercial insurances have stopped reimbursing medical offices, including ours, for nearly four weeks.
In asking these health plans for clarification, all we’ve heard is crickets.
When you or I call our insurance companies about this, we get told “there is nothing wrong” and “payments are being made.”
There is either a major breakdown in the communication in these health plans or they are lying.
Change Healthcare is a juggernaut in the health-care world, processing 15 billion claims totaling more than $1.5 trillion a year, the company says [1]. It operates the largest electronic “clearinghouse” in the business, acting as a pipeline that connects health-care providers with insurance companies who pay for their services and determine what patients owe. It supported tens of thousands of physicians, dentists, pharmacies and hospitals, handling 50 percent of all medical claims in the United States, the Justice Department wrote in a 2022 lawsuit that unsuccessfully tried to block UnitedHealth from acquiring the company [2].
Because of this financial fiasco, small and medium sized clinics are scrambling to stay open.
Today many have closed their doors, because of financial payment and reimbursement coming to a screeching halt.
This has dramatically exposed the fragility of the insurance and billing systems that underpin American health care.
Our office, for example in the last four weeks, has only been paid 10% of what we’ve billed out.
It is not possible to pay staff and keep the lights on in a medical office when you don’t actually get paid. Most small offices have about a 1-2 week cushion before they are forced to close the doors.
Who really knows if this actually was a cyber-attack?
Because EVERY insurance company including Medicare and hospital systems, have stopped paying in the last three weeks.
Sadly, insurance companies have said nothing directly to us as providers, until today. As of today, they are claiming payment will start up by the end of the month.
All the information I have gained about this has come directly through the media. They claim that this has prevented insurance payments from processing, leaving many care providers and pharmacies to float the bill up front and hoping to get reimbursed.
After 25 years of medical practice, and dealing with problems like this year after year (Medicare frequently just stops paying in January for no reason), this is the last straw. My office will no longer be accepting any insurance as of May 1, 2024.
We convert to a cash/fee for service/concierge practice.
Because insurance has still not reimbursed us, our office is requiring a $150 retainer which is for services rendered on the day of service between now and May 1, 2024, or until insurance companies compensate us for the services we’ve rendered and the billing we are due. This retainer is refundable upon receipt of your insurance payment or can be added as a credit on your account toward your deductible.
You can pay this retainer and we are happy to see you, or you can reschedule with us and call your insurance company and find out why they are not paying.
We are sorry for the inconvenience that this is causing.
As of today, you have other alternatives. They are:
Begin our yearly concierge service – $4500 per year – all medical services in the office including quarterly labs are covered (this does not include spa services).
For Visits with Dr. Nally, you can pay cash or card at the time of service at the rates below:
Establish Patients New Patients
10 minutes – $90.00 10 minutes – $140.00
20 minutes – $130.00 20 minutes – $180.00
30 minutes – $190.00 30 minutes – $240.00
40 minutes – $250.00 40 minutes – $290.00
60 minutes – $350.00 60 minutes – $450.00
Visits with our nurse practitioner are billed at 75% of the rates above.
Additional fee for service pricing can be seen in the office.
I realized this will dramatically change our practice. However, this is the only way our office will be able to continue to provide solid and effective medical care.
To your health & longevity,
Adam Nally, DO
References:
- https://community.changehealthcare.com/developers/eligibilityandclaims
- chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://www.justice.gov/atr/case-document/file/1476901/download
