Navigating the Complicated World of Change Healthcare: Understanding Their Role in Healthcare Data Management

If you, like many kidney patients, received a notice from Change Healthcare, you might wonder, Who on earth is Change Healthcare? This article aims to clarify the role of Change Healthcare within the healthcare industry, the implications of their data breach, and the actions being taken by affected individuals.

Understanding Change Healthcare

Change Healthcare is one of the many mid-level players in the healthcare industry that often goes unnoticed by consumers. Although they play a crucial role in managing revenue and payment cycles, their involvement comes at a cost to patients who never consented to their participation. Simply put, you pay for their services without gaining any benefit.

According to their official description, Change Healthcare Inc. is a provider of revenue and payment cycle management services. They connect payers, providers, and patients within the U.S. healthcare system. However, this description masks the inconvenient reality that these services come with hidden costs to consumers.

The Role of Change Healthcare

Health insurers benefit from companies like Change Healthcare because they help manage cash flow, verify patients' insurance coverage, standardize claims data, and transmit claims to insurers. They act as intermediaries in the healthcare system. If we had a single-payer health system, such companies would not exist, as overhead costs would drop significantly, and privacy breaches would be a rarity.

Alternative solutions like a single-payer health system could greatly reduce the risk of data breaches and the need for such companies. However, the current system poses significant risks to consumer data, and victims have no legal recourse.

Data Breach and Its Implications

Received a letter about a data breach from Change Healthcare? It's legitimate. Change Healthcare, previously known as WebMD and later as Emdeon, is a large health insurance clearinghouse headquartered in Nashville, TN, USA. They process health insurance claims and payments by serving as an intermediary between providers, hospitals, physicians, and payers.

Since at least 2010, Emdeon (prior to its renaming as Change Healthcare) used various versions of data formatting. The clearinghouse translated inbound data into an Emdeon-proprietary format, ran validation tests, and then translated that internal format into the desired outbound format to be passed along to the final destination. As of 2010, Emdeon was the largest healthcare clearinghouse in the USA, supplying statistical data to the government and insurance companies.

Actions and Recourse for Affected Individuals

As a result of the data breach, many individuals have received notices and been informed that they will receive two years of identity theft monitoring through IDX. However, there are some inconvenient catch-22s for affected individuals:

They cannot extend their existing credit monitoring membership using this latest breach notice. Individuals are required to create a new account, further increasing their risk of fraud. Over time, each online account increases the risk of identity theft.

It is essential to monitor your credit score more frequently for a while to catch any unauthorized activities. Despite the inconvenience and lack of clear recourse, individuals are left with no choice but to sign up for identity theft monitoring again, furthering their risks.

Companies like Change Healthcare should be held accountable for their actions and for risking consumer identities. Yet, as it stands, they continue to operate without significant repercussions.