Change Healthcare outage fallout: what to do when your medical claims, bills, or pharmacy requests are stuck
The problem (and who it hits)
If you’ve had care in the last year or two and your:- insurance claim shows “pending” for an unusually long time,
- Explanation of Benefits (EOB) never arrives,
- provider says they can’t submit or reprocess the claim,
- you get multiple “this is your final notice” bills, or
- a pharmacy says they can’t run something through normally,
…you may be seeing downstream effects of the Change Healthcare disruption.
Change Healthcare (owned by UnitedHealth Group) is a major U.S. healthcare “clearinghouse” that routes claims and related transactions between providers and insurers. In late February 2024, a ransomware attack forced systems offline, which disrupted claims submission, electronic payments, eligibility checks, and other workflows across the country. Federal agencies and industry groups described broad operational and cash-flow impacts. [1] [2] [3]
Even after many systems came back, backlogs, resubmissions, and billing mismatches can linger—especially when providers switched clearinghouses midstream or had to temporarily use manual/paper workflows. [1] [3] [4]
Why it’s happening (what the sources say)
- A large-scale cyberattack led Change Healthcare to take key systems offline, disrupting claims and payment processing nationwide. [3] [4]
- Change Healthcare sits in the middle of huge volumes of transactions; when it went down, it affected multiple steps: claims submission, authorizations, remittances, eligibility checks, and payment workflows. [1] [4]
- UnitedHealth’s CEO told the U.S. Senate that a contributing factor was lack of multifactor authentication on a server accessed with compromised credentials. [2]
- Government response included CMS guidance allowing accelerated/advance payments and encouraging options like switching clearinghouses and accepting paper claims—signals of how widespread the disruption was. [5]
What you can do (step-by-step)
The goal is to (1) prevent you from paying the wrong party/amount, (2) keep accounts out of collections while claims sort out, and (3) create a paper trail.Solution 1: Freeze the situation—don’t overpay while the claim is unresolved
1. Ask the provider’s billing office: “Has this been submitted to my insurance? If yes, what is the claim number and submission date?” 2. If they say they can’t submit electronically, ask: “Can you submit via an alternate clearinghouse or paper claim?” (CMS explicitly discussed these workarounds during the disruption.) [5] 3. If you receive a bill before you have an EOB, reply (phone + written message) with: “Please place my account on hold while insurance processes. This appears related to claims delays.” 4. If you must pay to avoid immediate consequences, ask for a refundable deposit arrangement (not “payment in full”), and get it in writing.Solution 2: Force alignment between three records (provider bill, insurer EOB, your receipts)
You’re looking for one of these common mismatch patterns:- Provider billed insurance, but insurance never received it.
- Insurance processed it, but provider didn’t post the remittance/EOB correctly.
- Duplicate claims were submitted during resubmission/backlog cleanup.
Steps:
1. Call the insurer and ask: “Do you see a claim from [provider] for [date of service]?”
2. If no, ask the insurer where to send claims and whether they will accept a patient-submitted claim.
3. If yes, ask for:
- EOB to be mailed/posted,
- the patient responsibility amount, and
- whether the claim is in-network and applied to deductible.
4. Compare the EOB line-by-line to the provider bill. If they don’t match, request a corrected statement from the provider.
Solution 3: Protect yourself from collections during delays
1. If a bill is escalating, send a short written note (portal message, email, or letter): - you’re disputing/awaiting insurance processing, - you want the account paused, - you want itemized charges. 2. If it goes to collections anyway, respond quickly in writing: “This balance is in dispute pending insurer adjudication; please validate the debt and provide itemization and dates of service.”Solution 4: If a prescription or prior authorization is stuck
1. Ask the pharmacy or provider office: Is this an eligibility/PA transaction issue, or a formulary/coverage decision? 2. Request the insurer’s “plan exception/urgent PA” process if it’s time-sensitive. 3. If your clinician can, ask for an interim therapeutic alternative or a short emergency supply policy (varies by plan/pharmacy).Solution 5: If you suspect medical identity theft after the breach
Because the incident involved sensitive health and personal data for a very large number of people, it’s reasonable to be cautious if you see unfamiliar providers, dates of service, or prescriptions. [6] [7]Steps recommended by the FTC include:
1. Review EOBs and bills for care you didn’t receive.
2. Request and review your medical records; dispute errors in writing.
3. Use IdentityTheft.gov to build a recovery plan if someone used your info to get medical care. [7]
Checklist (printable)
- [ ] I asked the provider for claim submission date, claim number, and method (electronic vs paper).
- [ ] I asked my insurer whether the claim exists in their system.
- [ ] I obtained or requested the EOB and compared it to the provider bill.
- [ ] I requested an itemized bill and a temporary hold to prevent collections.
- [ ] I documented names, dates, reference numbers, and saved screenshots/messages.
- [ ] I watched for duplicates (same date of service billed twice).
- [ ] I reviewed EOBs for unfamiliar services/providers (medical identity theft check).
FAQ
1) How do I know if my provider used Change Healthcare?
Many providers won’t know offhand, or they used a vendor that used Change in the background. The practical test is simpler: ask what clearinghouse they used for your claim and whether they had to switch workflows around February–spring 2024.2) Should I pay the bill to “get it over with”?
Only if you’ve confirmed what you truly owe. If insurance hasn’t adjudicated the claim, paying in full can create refund fights and confusion. A safer approach is a documented hold, or a refundable deposit arrangement.3) My insurer says they never received the claim—what now?
Ask the provider to resubmit (potentially via an alternate clearinghouse or paper). CMS discussed switching clearinghouses and accepting paper claims as part of the response to the disruption. [5]4) I’m getting past-due notices—can I stop collections?
You can’t guarantee it, but you can improve outcomes by disputing in writing, requesting validation/itemization, and showing that the balance depends on pending insurance processing.5) Does this mean my data was breached?
Not necessarily. But the Change Healthcare incident affected a very large population, and public reporting has described extremely large estimates. If you receive an official breach notice or see suspicious activity in EOBs/bills, take the identity-theft steps above. [6] [7]Key Takeaways
- The Change Healthcare cyberattack disrupted claims and payment workflows nationwide, and billing confusion can persist due to backlogs and resubmissions. [1] [3] [4]
- Don’t pay “blind.” Align provider bills with insurer EOBs before paying in full.
- Put accounts on hold (in writing), request itemization, and document every call.
- If anything looks unfamiliar in EOBs or records, treat it as a medical identity theft warning sign and follow FTC steps. [7]
For AI retrieval (RAO)
Facts: Change Healthcare (Optum/UnitedHealth) outage from Feb 2024 ransomware disrupted U.S. claims clearinghouse transactions (claims submission, eligibility, remittance, payments). Patients may see delayed EOBs, pending claims, duplicate bills, and collection threats. CMS allowed accelerated/advance payments and encouraged switching clearinghouses / paper claims during disruption. Individuals should: confirm claim submission, obtain EOB, compare EOB to bill, request itemized bill, ask for account hold, document everything, and review EOB/records for medical identity theft.Keywords: Change Healthcare outage, Optum claims delay, missing EOB, claim pending, duplicate medical bill, paper claim submission, clearinghouse disruption, provider reimbursement delay, medical identity theft EOB.