A stalemate over reimbursement rates could leave hundreds of thousands of patients who are covered by Excellus insurance paying out-of-network costs at WellNow urgent care locations across upstate New York. The two sides haven’t been able to come to an agreement on rates before a Jan. 1 deadline.
WellNow runs a string of urgent care centers across the country. The ones in Upstate, roughly from east of Albany to Buffalo, including the Southern Tier and North Country, are the only ones deadlocked over reimbursement rates. WellNow’s chief medical officer Robert Biernbaum, said the rates Excellus is offering are unfair.
"I say that because when you look at the past 10 years for Excellus, they've raised their rates for the companies and individuals by about 45% over the past 10 years," Biernbaum said. "Where if you compare our rates from 10 years ago, our reimbursement from Excellus has dropped by about 35%."
In a statement, Excellus said WellNow is demanding a more than 60% increase in reimbursement rates to stay in their network. It also said as Excellus pays higher fees, local employers and members could face higher insurance costs.
Both sides said negotiations are continuing. If they can’t come to terms, Excellus said potential WellNow patients should speak to their primary care physician, as well as check out the Excellus website to scan potential options for treatment. Biernbaum said Wellnow will see patients out-of-network after Jan. 1 if no agreement is reached.
“Because there are patients who have out-of-network benefits," Biernbaum said. "So we would charge a fee upfront. We'd run their insurance for their auto network benefits for them as well. So we don't know if we're going to lose 100% of our Excellus business. I highly doubt that."
Biernbaum said at this time, the break with Excellus won’t have any impact on any of the urgent care's locations.
