Thousands of Central New Yorkers insured by Excellus Blue Cross/Blue Shield might be paying more for urgent care starting in January if the company can’t reach an agreement with a key provider. The dispute with Chicago-based WellNow Urgent Care stems from reimbursement rates.
WellNow claims Excellus has increased its rates on patients by 45 percent since 2016, while the company has cut payments to urgent care by 35 percent. Chief Medical Officer for WellNow Doctor Robert Biernbaum says it doesn’t compute:
“When we're looking at an increased price every year over the past 10 years, with reimbursement going down," Biernbaum says. "The math makes no sense to anyone.”
Biernbaum says they’re waiting on Excellus to come back with an offer. Excellus declined an interview. In a statement, officials say they’ve actually increased reimbursement rates for WellNow, and that the company’s demands for a more than 60 percent rate increase are unreasonable. Excellus says those fees translate to higher costs for local employers and members.
Biernbaum with WellNow counters that their centers fill a gap in health care for many communities, especially rural areas.
“We are one of the only healthcare providers there other than than hospitals. They [rural areas] struggle, obviously, with primary care," Biernbaum said. "I think this is going to have a very large impact throughout the region, more specifically on healthcare deserts, where their only other choice is going to be going to an emergency department, which is 10 to 15 times the cost.”
If Excellus and WellNow can’t reach an agreement by January 1, Biernbaum says they’ll have no choice but to go out of network, which will sharply increase costs for patients who may then decide to delay care.
“This is the last thing that we want. We don't want this for our communities," Biernbaum said. "We don't want this for communities that we may be the only place that that serves other than an emergency department, because people that have to decide on cost over care. That's a scary position to be in, and I just don't want families to go through that.”
For its part, Excellus accuses WellNow of launching a public campaign that misrepresents the facts, causing confusion and uncertainty for members. Excellus says it stands ready to help members with any questions should WellNow choose to leave the network.
Editor's note: Excellus Blue Cross/Blue Shield is a financial supporter of WAER, which is licensed by Syracuse University. The company also provides health care coverage for many Syracuse University employees.
