Deadline looms for agreement on reimbursement rate between Excellus and WellNow
ROCHESTER, N.Y. — The January 1 deadline is fast approaching for Excellus and WellNow to reach an agreement on reimbursement rates.
If you’re an Excellus customer, your visits may not be covered in the new year.
Dr. Robert Biernbaum, chief medical officer for WellNow urgent care says this could potentially affect hundreds of thousands of patients. They’re asking Excellus to give them a fair and reasonable reimbursement, based on the work they do.
Dr. Biernbaum says he’s worried some rural areas will be faced with a shortage of options for care, if no agreement is reached.
Excellus says WellNow is asking for a rate increase that would far exceed provider reimbursement for comparable services.
“They don’t even understand what we do for the community,” says Dr. Biernbaum. “When you are comparing us to a primary care, who doesn’t have x-rays, doesn’t perform procedures we perform, doesn’t open after hours and on weekends — it’s a comparison that means they don’t understand, nor do they care to understand, the service that we give to their patients.”
Excellus released the following statement to News10NBC:
“WellNow, based in Chicago, is part of a rapidly-growing, for-profit organization. They’ve asked for a reimbursement increase that is significantly more than what we reimburse local doctors for similar services. Our analysis shows that WellNow is demanding a more than 60 percent increase in reimbursement rates to remain in our network.
WellNow seeks favorable reimbursement over our local providers who provide a tremendous amount of high-quality care to our members.
When we pay higher fees, local employers and members can face higher health insurance costs.
We continue to engage in contract discussions with WellNow. However, we cannot agree to WellNow’s unreasonable demands of a more than 60 percent rate increase. This would run counter to our mission to keep health coverage as affordable as possible for our members while ensuring access to care.
As a nonprofit health plan, we spent 91 cents of every premium dollar collected in 2022 to pay our customers’ medical claims and activities that improve the quality of care. Over the past 20 years our annual net income has averaged less than 2 percent of premium.”