Auburn urgent care ends insurer agreement, costs to spike [The Citizen, Auburn, N.Y.]

Nov. 2—An urgent care provider with a location in Auburn has terminated its agreement with a major health insurer, increasing costs for subscribers by as much as 1,500% beginning next year.

In a letter this week, WellNow Urgent Care, of East Syracuse, ended its Participating Physicians Agreement with Excellus BlueCross BlueShield, of Rochester. According to the letter, which was shared with The Citizen by WellNow on Thursday, it ended the agreement due to Excellus' "intractable position ... to keep reimbursement rates well below historical reimbursement over the past decade."

Excellus has maintained that position despite receiving a 45% increase in premiums from the New York State Department of Financial Services since 2017, WellNow founder John Radford wrote.

That and "failure to recognize and appreciate the distinction between primary care practices and urgent care centers makes our business relationship an untenable proposition," he continued.

Radford went on to accuse Excellus of reimbursing other urgent care centers at rates four to five times as high as the one WellNow receives, "taking advantage of regional market dominance to squeeze our urgent care providers and (failing) to appreciate fundamental fairness in setting rates that reflect the growing cost of delivering quality health care post-pandemic."

As a result of the termination, Excellus will become an out-of-network insurer at WellNow Urgent Care locations beginning Jan. 1.

Out-of-pocket costs for Excellus subscribers will increase from a copay of $10, $15 or $20 to $165 plus actual costs, WellNow representatives told The Citizen.

In a statement to The Citizen, Excellus spokesperson Joy Auch said the insurer and WellNow 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," Auch said. "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."

According to data provided to The Citizen, last year there were 13,967 visits to the Auburn location of WellNow, which opened at 271 Grant Ave. in December 2018. The provider has 85 locations in New York and more than 125 spanning Illinois, Indiana, Michigan, Ohio, Pennsylvania and Wisconsin. Locations provide walk-in treatment for illness, injury and other health needs, as well as testing.

WellNow representatives did not have data on the number of visits to the Auburn location that were covered by Excellus last year. According to Radford's letter, the number of patients covered by the insurer who visited all of the urgent care provider's locations in New York last year was almost 300,000. Many reside in what Radford described as "health care deserts" in central and western New York.

The WellNow founder expressed hope that its agreement with Excellus can be renewed with updated reimbursement rates.

"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," he wrote. "We are proud to play a critical role in the communities we serve (and) proud to close the gaps in health care coverage."

Executive Editor David Wilcox can be reached at (315) 282-2245 or [email protected].

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