SYRACUSE (WSYR-TV) — After more than a year trying to negotiate with Excellus BlueCross BlueShield, WellNow urgent care announced in October that they will no longer accept Excellus effective Jan. 1, 2024, because of “unfair rates.”
In September, WellNow announced they were temporarily closing locations and that’s because the company was sending a warning to Excellus, urging them to update “current and renewal reimbursem*nt rates that reflect both the cost and the value of the services WellNow Urgent Care centers provide.”
In its warning letter sent to Excellus on Sept. 30, WellNow stated Excellus “failed to commit to reasonable reimbursem*nt rates for the critically important, quality healthcare services WellNow Urgent Care centers deliver to Excellus insureds in communities throughout Central New York.”
They gave Excellus 30 days to mutually agree with its terms from the date of the letter, but now that it’s past the 30 days, WellNow said they have “no choice but to exit our business relationship with Excellus effective Jan. 1, 2024, and go out of network.”
According to WellNow, Excellus has been unwilling to commit to current and renewal rates greater than 2017 levels.
“Excellus’s rates are significantly less than those other similar plans pay, despite Excellus — like clockwork almost every year — increasing the premiums it charges its insureds. To add insult to injury, Excellus’s rate structure unfairly penalizes WellNow for testing services our urgent care centers provided during the COVID-19 pandemic,” stated WellNow.
However, Excellus says that although WellNow said the health plan reduced their reimbursem*nt rates since 2017, Excellus BCBS actually increased WellNow’s rates during that time.
WellNow has 13 locations across Western and Central New York, and even then, the company says there are “healthcare deserts.”
“As data shows, urgent care centers save money for insurance carriers such as Excellus by servicing patients who would otherwise be forced into hospital emergency rooms where costs are higher, wait times are longer, and distances to travel are farther for most patients,” stated WellNow.
WellNow says Excellus knows this and is “picking and choosing which urgent care centers receive rates for comparable services to WellNow, with other centers receiving up to 4-5x what WellNow receives in reimbursem*nt from Excellus.”
After hearing news of the decision, Senator John W. Mannion, Assemblymember William B. Magnarelli, and Assemblymember Monica P. Wallace all sent letters to Excellus, urging Jim Reed, chief executive officer of Excellus BlueCross BlueShield, to reconsider.
“We urge you to immediately return to the table and negotiate a mutually beneficial solution to provide access and insurance coverage to quality healthcare at 13 WellNow locations across Central New York,” stated Mannion in his letter.
Reed responded to Mannion’s letter by saying “While I understand WellNow seeks a significant increase in unit cost reimbursem*nt, we cannot responsibly accept the proposal they presented.”
In addition, Reed alleged that WellNow has “engaged in an aggressive campaign seeking support from the media, politicians, and patients” and said that Excellus disagrees with “the accuracy of their allegations.”
Joy Auch, a spokesperson for Excellus BlueCross BlueShield, stated in October that the company will continue to engage in productive and collaborative discussions with WellNow.
“We continue to negotiate in good faith in the hopes they will agree to remain a participating provider in 2024. We believe in reimbursem*nt rates that are fair and equitableand fulfill our obligation to help keep health coverage as affordable as possible for our members while ensuring access to care. WellNow, however, has asked for a rate increase that would far exceed provider reimbursem*nt for comparable services,” stated Auch.
At this time, BlueCross BlueShield members may continue to access WellNow services under their benefit plan. Excellus says they will provide members with additional details and information if they’re unable to reach an agreement with WellNow by the end of 2023.
“If WellNow leaves our provider network, they’ll become an out-of-network provider. Members will pay more for out-of-network care. Most members have benefits that could cover some of the costs. Coverage varies based on benefits,” stated Excellus.
When this happens, members can log in to their online account to view plan coverage or call the Customer Care phone number on the back of their member card. Customers can also call that number if they were charged out of network early by mistake and get a refund.
Locations and phone numbers of WellNow’s near you can be found here. If customers have any issues with their bill they can email billing@wellnow.com and for those who want to learn more and take action with WellNow, click here.
However, those with BlueCross BlueShield will need to pay out of pocket starting Jan. 1, 2024.
For more information, read the fact sheet below provided by Excellus BCBS.
