ROCHESTER, N.Y. (WROC) — WellNow Urgent Care announced that they are planning on ending their business relationship with Excellus BlueCross BlueShield by the start of next year if the company does not pay “fair rates.”
According to a release sent out by WellNow, it is unsustainable for WellNow to continue doing business with Excellus due to Excellus’s failure to commit to reasonable rates. It was alleged that Excellus’s rates for WellNow patients decreased despite them raising rates for insured members.
“Excellus has been given permission by the New York Department of Financial Services to raise its premiums almost every year. By our calculation, that’s more than an 8 percent increase in premiums each year for their customers since 2017,” said WellNow President Sam Meites. “Yet, they don’t want to commit to reasonable rate increases that would help pay for the dedicated healthcare professionals who have worked proudly to meet New York’s urgent care needs.
WellNow says that many areas of Upstate New York have struggled with poor access to healthcare, also known as “healthcare deserts.” The company added that seven WellNow facilities were closed due to Excellus’s rates.
“Because we haven’t been able to get Excellus to negotiate since 2016, reimbursement rates have dropped by 35 percent, while inflation has skyrocketed,” said WellNow CMO Dr. Robert Biernbaum. “Insurance executives like to hold high their nonprofit status and talk about the claims they paid.”
WellNow clarifies on its website that it will not turn away patients, but it does mean that, if the relationship ends, it will stop accepting Excellus insurance until they start paying providers fairly.
In addition, Citizen Action of New York announced that they will hold a rally against Excellus, alleging that the company is denying care to it’s members.
Stay with News 8 WROC as we continue to update this developing story.
Full Statement from WellNow’s Chief Medical Officer Dr. Robert Biernbaum:
“Excellus reveals its fundamental misunderstanding of urgent care by calling WellNow Urgent Care centers ‘primary care.’ Urgent Care centers like WellNow bridge the gaps between primary care physicians and emergency rooms by offering communities high quality, affordable and convenient healthcare options. Nationally, it is estimated that urgent care centers prevent around 24.5 million emergency room visits annually, which saves insurance companies like Excellus a lot of money when you consider that the average cost of an emergency visit is $1,646, while the average Urgent Care visit cost is only $171.
WellNow Urgent Care was founded in Western New York to help communities bridge the widening gap between urgent care needs and the shrinking emergency room capacity across New York, especially in the rural and urban underserved communities. Rural hospital closures hit communities hard and WellNow has expanded to more than 70 care centers throughout Upstate New York which employ more than 2,500 people.
Studies show urgent care centers such as WellNow are likely saving hospital emergency departments millions by offering people alternatives for lesser illnesses and injuries according to the National Institutes of Health. Urgent care goes far beyond primary care with more advanced procedures like treating lacerations, fractures, and conducting x-rays to provide rural communities with a continuum of care. However, the truth is that without better rates from insurance providers like Excellus, there’s a very real threat to the care that Urgent Care centers provide across the state of New York. Unfortunately, seven Wellnow urgent cares in New York have had to close this year because of inadequate rates from Excellus.
Because we haven’t been able to get Excellus to negotiate since 2016, reimbursement rates have dropped by 35 percent, while inflation has skyrocketed. Insurance executives like to hold high their nonprofit status and talk about the claims they paid. Public records reveal Excellus collected $6.6 billion in premiums in 2022 and raised premiums by a whopping 45% since 2016. Records show millions in surplus “profits” in 2022 and pay for its top four executives exceeded $6 million. Pretty good for a local nonprofit.”
Full Statement from Excellus BlueCross BlueShield
Excellus BlueCross BlueShield is a locally-based, nonprofit health plan serving upstate New York. Our mission is to keep health care as affordable as possible so that as many people as possible can have access to needed medical services. Over the past 20 years our annual net income has averaged less than 2 percent of premium. In 2022, we spent 91 cents of every premium dollar collected to pay our customers’ medical claims and activities that improve the quality of care.
Excellus BlueCross BlueShield is engaged in active discussions with WellNow Urgent Care around their participating provider status with us in 2024. We’ve had our current contract with WellNow since 2016 and we’re hopeful they will agree to remain in our network.
WellNow has asked for a rate increase that would far exceed local primary care provider reimbursement. Given the fact that a majority of the services Wellnow provides to our members is primary care based, we do not think it’s fair to advantage WellNow over our local primary care providers who offer similar services in our communities.
WellNow, a for-profit company based in Chicago, has notified us that in the event an agreement is not reached within 30 days, they intend to leave the network effective Dec. 31, 2023.
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 for 2024.Joy Auch, spokesperson, Excellus BlueCross BlueShield