SYRACUSE (WSYR-TV/WROC) — After more than a year of trying to negotiate with Excellus BlueCross BlueShield, WellNow Urgent Care announced Tuesday that they will no longer accept Excellus because of “unfair rates” at of the end of the year, if the two cannot reach an updated contract agreement.

Just last month, 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 reimbursement 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 reimbursement 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 January 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.

WellNow has 13 locations across Western and Central New York, and even then, the company says there are “healthcare desserts.”

“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.

However, 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 four to five times what WellNow receives in reimbursement from Excellus today.”

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 reimbursement, 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.”

Those with BlueCross BlueShield may soon need to start paying out of pocket starting Jan. 1, 2024.

Excellus has responded to this situation, saying that WellNow informed them they will be leaving at the start of January. Joy Auch, a spokesperson for Excellus BlueCross BlueShield says that the company believes their reimbursement rates are fair and that WellNow asked for a rate increase. Auch said in part:

“We believe in reimbursement rates that are fair and equitable and 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 reimbursement for comparable services.”

Auch continued and said that Excellus members will be able to continue access to WellNow services in accordance with their plan. Excellus is working to continue discussions and find a resolution before the end of the year.

Full Statement from Excellus BlueCross BlueShield

Although WellNow has notified us of their intent to leave our network effective Jan. 1, 2024, we continue to engage in productive and collaborative discussions with them. We continue to negotiate in good faith in the hopes they will agree to remain a participating provider in 2024.

We believe in reimbursement rates that are fair and equitable, and 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 reimbursement for comparable services. 

At this time, members may continue to access WellNow services in accordance with their benefit plan. We will provide our members with additional details and information if we’re unable to reach an agreement with WellNow by the end of 2023.

— Joy Auch, spokesperson for Excellus BlueCross BlueShield.