By: David Ostrowsky
Late last month, an apparent massive cybersecurity incident involving the potential theft of patient data – this could entail personally identifiable information, sensitive health information, and financial information -- and encrypted company files seemingly paralyzed one of the nation’s largest pipelines for healthcare payments and prior authorization processing. Impacting a substantial percent of Americans’ medical claims (billions of claims totaling over a trillion dollars per year), millions have been affected. But perhaps the worst part is that many don’t even know it – and won’t be aware until they need to visit their physician or refill a prescription and face new hurdles in getting their customary treatment.
Just this week, The Washington Post published stories of patients getting billed hundreds of dollars for prescriptions that had normally been fully covered by insurance. Meanwhile, others cannot get their prescriptions filled at all no matter how much they are willing to pay and still others have found that discount coupons are no longer effective (this can literally save a person hundreds of dollars per month on a given prescription). For Americans living on airtight budgets, which is certainly a great number of our fellow countrymen, they’ve had to forego taking medications for an untold number of physical and psychiatric conditions. While it’s by no means a long-term fix, some physicians have provided their patients with sample packs of pills or offered more affordable replacement prescriptions for those needing to pay out of pocket. But we all know this band-aid solution will only go so far.
As this horrific situation has been playing out across pharmacies throughout our country, physicians in both massive hospital networks and small clinics are struggling to obtain prior authorization for exams, medications, and procedures; subsequently, many patients have faced significant delays in receiving life-altering and/or life-prolonging medical care. Such delays have also been exacerbated by the unfortunate reality that some hospitals and medical providers have not received payments and thus lack the wherewithal to keep their employees. As it is, many medical practices throughout America do not carry significant cash reserves and entirely depend on healthy cash flow to execute claim submission and payment on a timely basis as well as keep up with payroll. For facilities that administer the most expensive services (i.e., chemotherapy and other forms of cancer drugs), burning through cash reserves can mean being unable to treat patients in dire need.
Simply put, the residual effects of this historically monumental data breach are endless – and, for many of the most vulnerable Americans who are already living on the margins of society, there appears to be no end in sight to physicians and hospitals not receiving adequate funding from private insurers, Medicare, and Medicaid.
As Molly Fulton, the chief operating officer of Arlington Urgent Care, a chain of urgent care centers around Columbus, Ohio, that’s currently carrying over $650,000 in unpaid insurance reimbursements, told the New York Times, “This is worse than when Covid hit because even though we didn’t get paid for a while then either, at least we knew there was going to be a fix. Here, there is just no end in sight.”