(Bloomberg) -- As the ripple effects from a hack on a UnitedHealth Group Inc. unit extend for more than a week, some health-care providers face an increasingly difficult dilemma: whether to deny medication to patients or risk not being paid for costly treatment.

For days, providers have been unable to verify if a patient’s health insurance will cover the cost of their prescription, typically an almost-instantaneous check that Change Healthcare, the victim of the cyberattack, provided to these businesses. However, operators of smaller pharmacies say they can only cover the cost of prescriptions — while they wait to be reimbursed — for so long.

Shaukat Zakaria, who manages an independent pharmacy in Houston, said his business, HealthQuest Therapeutics, has continued filling prescriptions for existing patients but is turning away some new patients, for which he has no previous knowledge of their insurance coverage. His company is awaiting reimbursement on a backlog of 140 claims.

“We can’t afford to not get paid,” Zakaria said. “Each one of our claims can range anywhere from $500 to up to $60,000.”

Read More: UnitedHealth Cites ‘Nation-State’ in Hack Disrupting Pharmacies

Change Healthcare processes insurance claims and pharmacy requests for over 340,000 physicians and 60,000 pharmacies. The hack, which was discovered on Feb. 21, shut down the Change network for health-care providers across the nation. UnitedHealth on Feb. 29 confirmed that the ransomware gang BlackCat was behind the attack. 

As the shutdown extends into March, it’s become more difficult to navigate a path forward for some companies within Change’s supply chain. Insurance premium payments are generally due around the beginning of the month. If a patient doesn’t pay their premium early this month, they could be dropped from their insurance plan. 

But it will be nearly impossible for health-care providers to know if a patient is still covered given the current circumstances.

“You may be filling medication that theoretically could cost $5,000, $10,000, $20,000, but the patient’s not even active with their insurance any longer,” said Dalia Kasseb, vice president of operations at Pyramids Pharmacy in Texas. In such a case, the pharmacy would have to eat the cost of the drug, a severe blow to smaller, independent stores. 

Ophthalmologist Matthew Gewirtz said he is choosing to continue performing eye procedures at his practice in New Jersey without knowing if or when he will be compensated. 

“They need to be done. If they’re delayed, then people can have permanent visual loss,” Gewirtz said. 

Read More: Fallout From Change Healthcare Hack Still Roils Health Care

While many providers continue to service patients and bear the brunt of the impact themselves, some patients are facing delays or outright refusal. Morgan Overbeck said she told by a local Walmart pharmacy in Houston that her medication was being delayed — ultimately by four days — because of the hack. 

“Usually I could get it in 30 minutes to an hour. It shouldn’t take four days. I think there has to be a backup plan if something like this happens again,” Overbeck said. 

A Walmart spokesperson didn’t immediately respond to a request for comment.

For a few days, health-care providers were using manual workarounds around the issue – calling up pharmacy benefit managers to verify if their patient’s care was covered. But according to Kasseb, the wait time for calling can be as long as two hours, and some of the services her pharmacy was using are no longer available.

“They’ve stopped doing that. I think they’ve gotten overwhelmed by the amount of calls,” Kasseb said. 

UnitedHealth on Friday said it would offer temporary funding without interest or fees to providers who can’t get paid due to the Change outage. It directed providers to register with UnitedHealth’s Optum Pay service to access the funds. UnitedHealth also published information about workarounds on a new response website and said an electronic prescribing service had been restored.

The company hasn’t yet said whether patient information has been compromised and offered no clarity on when the broader outage would be resolved.

If the claims are eventually paid, the lag time itself could still create financial problems for providers, who often operate on a strict payment schedule. Gewirtz, who spends money to finance his operations at the beginning of each month, usually is reimbursed with the cash received from claims at the end of the month. Without the compensation, his practice might have to pull their line of credit to stay afloat. 

“Small businesses don’t have the capital to indulge in providing unmeasured resources. You won’t survive more than a month,” Kasseb said. 

The Change outage disrupted retail pharmacies for two to three days, said Scott Wagner, interim chief executive officer of online prescription service GoodRx. Large companies including GoodRx quickly switched to other services to process transactions, he said.

Smaller competitors are weighing other options too, but usually without the financial cushion of their larger rivals. Zakaria said he is switching software providers to avoid the ongoing issues of the Change Healthcare hack.

“We don’t know if this is going to last another two days or two weeks. We really have no choice,” Zakaria said. 

Gewirtz said his practice might eventually have to make some hard decisions if the systems remain down, like cutting staff or halting patient care. Until then, they both are expecting to continue treating patients as they always have. 

“As a pharmacist, my oath tells me to do no harm and take care of patients. We’re praying that there’s no harm that’s going to eventually come down to us,” Kasseb said. 

--With assistance from John Tozzi.

©2024 Bloomberg L.P.