Officials with WellNow Urgent Care are standing by their decision to go out of network with Excellus Blue Cross/Blue Shield of CNY despite the potential impact on members. Chief Medical Officer with WellNow Dr. Robert Biernbaum is based in Rochester, and says Excellus is reimbursing clinics at different rates.
“Going 60 miles down the road to Buffalo/Western New York, we're actually treated as an urgent care and will reimburse at the level of an urgent care," Biernbaum said on a conference call with reporters. "But Excellus [CNY] is saying that they can't do that in the Rochester, Syracuse and Utica region and the reimbursement that we're being offered is being compared to a primary care physician.”
When asked in an email, Excellus BCBS of CNY officials did not provide an answer about the disparity.
Biernbaum says there is a difference between the two types of care.
“Obviously primary care is the backbone of our healthcare institution," Biernbaum said. "But often patients can't get in or they're not open in the evenings, not open on weekends. And there are items that primary care does not do, like repair lacerations, manage fractures, drain abscesses.”
Biernbaum says out-of-network Excellus patients now have to pay a flat fee of $165 per visit, versus a much lower co-pay. He’s concerned that some will delay care.
“Patients are confused and that, as a physician and leader that it really, really is, is troublesome," Biernbaum said. "So patients are showing up and they don't understand because this is foreign to patients. All they really want to do is receive care.”
Biernbaum says their clinics are seeing slightly less traffic, but that’s also typical for early January. WAER's John Smith noticed a closed building and empty parking lot Wednesday afternoon at the WellNow location on West Taft Road near Wegmans, but it's not clear why it was closed. Nothing was posted on the door.
Biernbaum says the ball is in Excellus’ court for future negotiation. In a statement, Excellus BCBS of CNY officials say it was WellNow’s decision to leave their provider network. Excellus says while they’re disappointed by the decision, their focus now is on assisting our members with questions they may have around plan coverage and options for care.
