Effective Monday, Jan. 1, WellNow Urgent Care is no longer accepting Excellus BlueCross BlueShield insurance.
WellNow Urgent Care severs ties with Excellus BlueCross BlueShield over reimbursem*nt rates
In a statement, Excellus confirmed that WellNow was removed from its provider network effective Monday after months of negotiating reimbursem*nt rates.
Excellus BlueCross BlueShield has made every effort to engage in good faith contract discussions with WellNow Urgent Care so they would remain in our network in 2024. WellNow, however, has declined our latest offer, which included an increase in reimbursem*nt. WellNow will be removed from our provider network effective Jan. 1, 2024. While we are disappointed by their decision, we’re prepared to help our members find the care they need.
Members can visit ExcellusBCBS.com/CareOptions to learn about options for care, including information on primary care doctors, telehealth and urgent care.
Excellus BCBS, headquartered in Rochester, New York, provides health insurance to nearly 1.5 million members.
WellNow and Excellus impasse could put further strain on hospital system in CNY
WellNow Urgent Care operates 75 clinics in New York State, with nearly 40 being located in Central and Upstate New York.
The cost of care without insurance is a current rate of $165 per visit, plus the possibility of additional fees based on the services needed.
People like Katrina Weeden and Zina Adjei who both use Excellus are concerned with the $165 rate and the stress this could put on the emergency rooms.
Weeden says, "Money-wise, it is concerning because if the co-pays go up, obviously, I am going to have to decide whether or not I can even go seek medical care as opposed to the lower co-pays right now where I would just automatically go."
While Adjei says, "With that raise in price for Blue Cross Blue Shield, that's going to put a damper on our people because now they gotta either go find a hospital, and a lot of hospitals aren't taking walk-ins as they used to."
When CNY Central reached out to WellNow for comment, they directed us to their Dec. 29 statement on the matter.
The latest offer from Excellus BlueCross BlueShield to Upstate New York's largest urgent care services provider is less than it paid ten years ago while over the same time period has convinced New York State to raise its prices by 45%.
"The potential large-scale disruption on health equity is immense as people in underserved communities are left to cope with fewer resources," said Dr. Robert Biernbaum, D.O., Chief Medical Officer for WellNow Urgent Care.
"Excellus is making a decision that will create more underserved areas and cost New York State taxpayers more for Medicaid," said Biernbaum.
Without WellNow in-network, Excellus subscribers will either pay out-of-pocket costs to use WellNow or Excellus will pay higher costs for urgent care services delivered in hospital emergency departments and hospital-owned urgent care centers. Some of those higher costs for Excellus subscribers are passed on to the state Medicaid program.
Medicaid provides coverage for health care services for millions of New York's children, veterans, pregnant women, people with disabilities and seniors. Last year, WellNow Urgent Care Centers delivered high quality care for nearly 200,000 Upstate visits which were covered by Medicaid.
Ironically, Excellus is poised to spend more of its money and more Medicaid money in 2024 to cover services in hospital emergency departments and hospital-owned urgent care centers instead of at WellNow centers.
"It just doesn't have to end this way," said Dr. John Radford, founder of WellNow Urgent Care. "Excellus is using its strong market position to pressure WellNow into an unfavorable agreement."
"In Western New York, where Excellus operates as Univera with less market dominance, they acknowledge WellNow as an urgent care and pay a fair rate. However, in Central New York, where Excellus has a larger market share, they present conflicting information, treating WellNow like primary care. Adding to the confusion, Excellus pays many hospital-owned urgent care centers in Central New York much more than what WellNow is asking under our existing contract in the Buffalo area," said Radford.
"It's quite simple – if Excellus pays us in Central New York what they pay us in Western New York, we will stay in network. Otherwise, we have no choice but to go out of network. At this point one must wonder based on their unwillingness to provide an offer of any merit and their slow responses, as these negotiations started nine months ago, if they have any interest in keeping us in network. Ultimately, I have concerns about Excellus's commitment to healthcare access – it feels like they're putting profits over the people of New York," said Radford.
