WellNow continues contract discussions with Excellus as deadline looms [The Daily Star, Oneonta, N.Y.]

Dec. 21—A deadline is looming imposed by WellNow Urgent Care for Excellus BlueCross BlueShield to increase its reimbursement rates, or the urgent care clinics may stop accepting Excellus insurance from patients seeking care after Jan. 1.

Although patients with Excellus — a locally-based nonprofit health insurance plan serving upstate New York — could still be treated at WellNow, they would see higher out-of-pocket costs from using an out-of-network provider.

Locally, the Oneonta WellNow clinic opened in 2017 and the Cobleskill clinic opened in 2021.

Some clinic locations have closed while others have had openings delayed.

WellNow announcing its intent to stop accepting Excellus after the new year due to a dispute over reimbursement rates, which WellNow feels are too low and unsustainable.

WellNow — founded in Big Flats, Chemung County, and now based in Chicago — held a press conference Monday, Dec. 18 with Dr. Robert Biernbaum, WellNow chief medical officer.

He said Monday that Excellus has raised its rates and premiums 45% during the past 10 years, while WellNow has seen a decline of almost 35% in its reimbursement rate in the same time period.

On how contract discussions are going, Biernbaum said that "the ball is really in Excellus' court."

"We feel that our ask from them is quite reasonable," he said, "and we are waiting on them to bring back an offer that is fair for us."

Patients may have to turn to the emergency room if there is no urgent care clinic in the area.

"Having patients come to the hospital for things that we manage in urgent care will overwhelm the hospital," he said.

When a patient is seen, WellNow is reimbursed a certain amount based on the level and nature of care. Over time, the reimbursement from Excellus has actually gone down, Biernbaum said.

"Before the pandemic, our reimbursement was higher than it is now," he said. "We went through a pandemic, stayed open, didn't lay off any team members, had testing-only sites, and we're still seeing a decrease in reimbursement from a payer ... They're actually paying and reimbursing less for any standard visit."

Joy Auch, Excellus BlueCross BlueShield spokesperson, said in a statement to The Daily Star Thursday that Excellus continues to engage in contract discussions with WellNow, but feels that it has misrepresents facts in a public campaign.

Renewal discussions between insurers and providers are a normal part of the contracting process, she said.

"However, we've become increasingly concerned with WellNow's statements which [have] caused confusion and uncertainty for our members," Auch said.

"It's important for members to know that the contract with WellNow is in place until at least December 31, 2023," she said. "Members shouldn't be asked to pay upfront payments beyond their copay or applicable deductible."

The rate increase WellNow has aske for is "significantly more than what local providers receive for similar services."

"When we pay higher fees, local employers and members can face higher insurance costs," she said. "WellNow is part of a rapidly-growing, for-profit organization based in Chicago. We cannot provide them preferential treatment over our local providers."

Auch also refuted Biernbaum's claim that Excellus reduced WellNow's reimbursement rates since 2017, saying that the health plan increased WellNow's rates during that time.

"Agreeing to WellNow's demands would run counter to our nonprofit mission to keep coverage as affordable as possible for our members while ensuring access to care," she said.

___

(c)2023 The Daily Star (Oneonta, N.Y.)

Visit The Daily Star (Oneonta, N.Y.) at www.thedailystar.com

Distributed by Tribune Content Agency, LLC.