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WellNow Urgent Care will drop Excellus BlueCross BlueShield over reimbursement dispute

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  • Staff Report 

WellNow Urgent Care has announced its decision to stop accepting Excellus BlueCross BlueShield from January 1, 2024, due to ongoing disputes regarding what it deems ‘unfair rates.’ The urgent care provider claims that despite over a year of negotiations, Excellus has refused to agree to reasonable reimbursement rates that reflect the cost and value of services offered in Central New York. The severance of the business relationship follows a 30-day warning period in which WellNow sought to pressure Excellus into updating their reimbursement structure.

DiSanto Propane (Billboard)

The conflict arises from Excellus’s alleged reluctance to adjust rates that have remained consistent since 2017, which WellNow argues are significantly lower than what other similar insurance plans pay. This has been particularly contentious concerning COVID-19 testing services, with WellNow claiming that Excellus’s rates unfairly penalize them. The provider emphasizes that urgent care centers like theirs offer cost savings for insurers by reducing emergency room visits, yet Excellus appears to be selective in which centers receive higher rates for comparable services.

In response to WellNow’s decision, New York state legislators have urged Excellus to resume negotiations, stressing the need for accessible quality healthcare in the region. Despite this, Excellus CEO Jim Reed has dismissed WellNow’s proposal for increased unit cost reimbursement as irresponsible. Meanwhile, Excellus spokesperson Joy Auch has indicated a willingness to continue negotiations, emphasizing a commitment to fair rates that balance member affordability and access to care. If no agreement is reached by year-end, Excellus members will need to pay out of pocket for services at WellNow facilities starting in 2024.