Change Healthcare Outage Recovery for Clients

Overview

Change Healthcare, one of the largest health information exchanges in the U.S., experienced a cyber security incident in late February and paused their online services. 

Like many insurance companies, hospitals, and pharmacies nationwide, Alma uses Change to verify  in-network coverage and submit claims to insurance for sessions with Alma providers. During this unprecedented outage, Alma was unable to run automated eligibility checks or submit claims to any of our network partners. 

Alma reconnected safely with Change Healthcare in April 2024, and we resumed submitting claims to individual health plans for processing at that time. However, reconnection was only the first step:  recovery from the Change outage is ongoing and widely varying across health plans. 

While some health plans have resumed posting processed claims to their client health portals with Explanations of Benefits (EOBs) as usual, other health plans may be 

  • Working through large backlogs of claims accumulated during the Change outage, and / or
  • Resolving technical and systems issues preventing claims outcomes from reaching Alma. 

Because of this widespread variation in health plan recovery status, we recommend that you reach out to your health plan directly if you have questions regarding claim processing timelines. You can find guidance on what to have on hand while calling your insurance company here: Contacting Your Insurance Carrier

If your health plan confirms that they have processed your claims, or if you see your processed claims in your health plan’s online portal, you can reach out to support@helloalma.com for support in adjusting your Alma invoices or outstanding deductibles. Our team will be happy to make appropriate updates for impacted sessions.

Invoice adjustments from the Change outage

Why do invoice adjustments happen?

For context to understand why you might be getting new Alma invoices: If you have in-network insurance, Alma issues initial invoices to you based on your health plan's estimate of your cost per session. We do this at the same time that we pay out your provider for sessions and submit insurance claims to your health plan for processing. 

During the claims process after your sessions, your health plan may uncover nuances of your benefits that were not apparent in initial estimates. Your health plan may determine that you owe more or less than was initially quoted. In these cases, Alma will adjust your invoices to reflect the final determination of the health plan. 

Ultimately, Alma must honor your health plan’s decisions regarding your benefits. You can read more about our eligibility estimates and billing process here

How does the ongoing Change recovery impact invoice adjustments? 

As individual health plans restore systems during Change outage recovery, we are seeing claims processing in large batches after long delays. In some cases, clients whose claims have not processed through their health plans since the initial February outage may see Explanations of Benefits (EOBs) for multiple sessions posting all at once to their health plan portal in June or later. 

When we receive large numbers of processed claims from health plans restoring services, some clients may also receive multiple invoice adjustments at one time. If your claims return to us showing an outstanding balance and your credit card is enrolled in autopay, then Alma’s systems will automatically charge you for all of your outstanding invoice adjustments at once.

How can I find more information about my processed claims? 

  • To find the most up-to-date status of claims processing with your health plan, you can either
    • Log into your health plan's online client portal or
    • Contact the phone number on the back of your insurance card. (For guidelines on what to ask the support agent, review: Contacting Your Insurance Company.)
  • If your health plan has not yet processed your claims, you can share your Alma session dates and estimated payment responsibility with your health plan's support agent.
    • Based on this information, they should be able to confirm what you can expect as a timeline for processing, as well as how much will be applied to your outstanding deductible (if you have one).
  • If your health plan has processed your claims but Alma has not yet adjusted your invoices, you can reach out to support@helloalma.com to expedite updates. Please include either a screenshot of your online portal or a call reference number from your health plan's support agent. Based on this information from your health plan, we will adjust your invoices to match your health plan's final determination accordingly. 

What are my options if I've already received invoice adjustments from Alma? 

  • Payment plans: You can reach out to our team support@helloalma.com to discuss payment plans to spread your charges out over time. We offer plans in 2-, 4-, and 6-week increments. Please note that, to be eligible for a payment plan, you will need a valid credit card to enroll in autopay, so that you can complete new invoices promptly. 
  • Appeals of claims outcomes: If you disagree with the outcomes of your most recent claims, you can reach out directly to your health plan to appeal their decision. Individual health plans’ appeal processes vary, but we recommend that you call the number on the back of your insurance card for more guidance. Your health plan may also have a specific Claims department that deals with disputes. For more information on what you will need to reach out to your health plan, read: Contacting Your Insurance Carrier

Outstanding deductibles

If your health plan includes a deductible that needs to be met before you can start using your insurance benefits, you may notice that your deductible hasn’t gone down yet, or isn’t going down as much as you expected, while your health plan recovers from the Change outage.. 

This is because health plans apply your payments to your deductible as part of the claims process. While Alma has been able to submit the backlog of accrued claims, your insurance payer's technical systems may still be recovering from the outage, causing a delay in claims processing. They may not yet have full insight into all of the payments you’ve already made towards your balance this year.

Alma will fully refund you for any amount that you have overpaid for sessions once we receive confirmation from the client’s health plan that you have paid off your deductible

However, we also understand that waiting for official notification from your health plan may mean a financial burden for you as you continue care. 

  • If you don’t see processed claims yet in your health plan’s online portal:
    Your health plan’s claims process may be delayed. However, if you have already paid invoices for Alma sessions that add up to more than your outstanding deductible balance, you can reach out to support@helloalma.com for support. We may be able to review your payment responsibility for future sessions based on past Alma invoices. 
    • Alma does not have visibility into medical expenses paid outside of Alma; we can only make adjustments based on invoices paid to Alma directly. 
    • Please note that we cannot adjust past invoices for Alma sessions until we receive either an Explanations of Benefits (EOBs) or direct notification from the health plan of how your claims have been processed
      .
  • If you see processed claims in your health plan’s online portal, but you are waiting for Alma to update invoices accordingly:
    We may be delayed in receiving notifications of claims outcomes from your health plan. You can reach out to support@helloalma.com directly with your Explanation of Benefits (EOBs) for processed claims to expedite Alma invoice adjustments and refunds.
    • Please note that we can only adjust past invoices based on existing EOBs. So, for example, if you had six sessions during the Change outage this year and your health plan portal shows four processed claims, we can only adjust the four invoices for the claims that your health plan has processed. 

Please note: 

  • If you believe that invoices paid outside of Alma will resolve your deductible, we will need to wait for confirmation from your health plan when they are able to process your claims. Unfortunately, Alma has limited visibility into claims processed for medical expenses for providers outside of Alma.

Autopay enrollments

Autopay is an Alma feature that allows you to save a credit card on file, so that you can easily stay on top of new invoices for copays or coinsurance from your provider without the hassle of having to remember to pay your invoices manually. 

If you are enrolled in autopay, you may be automatically charged for any changes to payment responsibility that your health plan ultimately determines you owe for your sessions. To learn more about invoice adjustments, you can review How Alma Processes Claims.

If you have questions about your enrollment in autopay, we recommend that you speak directly to your provider about options for paying your Alma invoices. Your provider may have specific practice requirements regarding autopay enrollment that you should bear in mind while deciding next steps. 

HRA and HSA payments

If you have an HRA or HSA as part of your benefits, you may be covered for Alma sessions once your health plan has processed your claims and applied your funds. However, Alma has limited visibility into third-party or additional benefits as part of our eligibility checks. This means that we may not be able to confirm upfront that your claims will process without cost, and we will need to wait until claims process to confirm what your payment responsibility should be.

If we cannot confirm your HRA or HSA benefits before claims process, we will not be able to adjust your payment responsibility until we have received official confirmation from your health plan of a $0 copay or coinsurance for sessions.

As a reminder, different health plans are recovering at different rates from the Change outage, and your health plan may be experiencing prolonged delays in processing that could impact the timeline when we can update your Alma invoices.

In the meantime, we recommend that you continue to pay your Alma invoices as normal to ensure that your provider receives prompt payment for services. Once we have resumed claims submission and your claims have been processed to show an HRA or HSA benefit, we will fully refund you for the amount above the final cost your health plan determined you owe. 

Data privacy

At this time, Change Healthcare has not shared any information on the risk to client data submitted to them by any insurance payer or third party during their cyber security breach. 

At the start of the outage, Alma disconnected our systems from Change Healthcare until we received confirmation Change Healthcare systems had been audited and deemed safe for use. We have resumed using parts of Change's services to receive processed claims, after reviewing security assurance reports provided by Change Healthcare.

Alma understands the importance of and is strongly committed to HIPAA compliance. We prioritize the privacy and security of your data. If we learn of a data breach involving your information, you will be notified in accordance with the law. You can also review Alma’s Privacy Policy and Client Terms of Use on our website.

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