As of the beginning of this month, New Yorkers who are insured by Excellus BlueCross BlueShield will no longer have coverage at WellNow Urgent Cares.
WellNow, a healthcare provider with eight urgent care locations in the Rochester area and over 70 other urgent cares statewide, recently requested rate increases from Excellus. However, Excellus, the health plan, argued that the proposed rates would have exceeded what they pay other local providers.
On January 1, WellNow Urgent Care made the decision to exit the Excellus BlueCross BlueShield network, leaving behind 1.5 million New Yorkers who were covered by their services.
According to a statement from an Excellus spokesperson on Thursday, WellNow made the choice to leave their provider network starting on January 1, 2024. Despite their disappointment with this decision, Excellus is now concentrating on supporting their members by addressing any concerns they may have regarding plan coverage and available healthcare options.
How this may affect WellNow employees, patients
In a letter addressed to patients, WellNow has expressed concern about the unsustainable rate provided by Excellus over the past decade. This flat rate has put a strain on the urgent care chain, potentially leading to the closure of certain clinics in New York. It is crucial for insurance carriers to establish fair pay rates to ensure the continued operation of these clinics.
With the potential closures of its sites, the urgent care chain has expressed concern for the 2,500 healthcare workers under its employ who may be affected.
The issue of insurance coverage has become a point of contention between WellNow Urgent Care and Excellus BlueCross BlueShield. The two entities find themselves at odds over the rates set for medical services. This dispute highlights the challenges faced by healthcare providers and insurance companies in negotiating fair and reasonable fees.
WellNow Urgent Care, a prominent urgent care provider, has been seeking to negotiate higher rates with Excellus BlueCross BlueShield. The company argues that the current rates do not adequately cover the cost of providing quality healthcare services. They claim that higher rates are necessary to sustain their operations and ensure the delivery of exceptional care to patients.
On the other hand, Excellus BlueCross BlueShield, a leading health insurance company, maintains that the rates offered to WellNow Urgent Care are competitive and in line with industry standards. They argue that increasing the rates would result in higher premiums for their policyholders, which may not be feasible or fair.
This clash between WellNow Urgent Care and Excellus BlueCross BlueShield reflects the broader issue of insurance coverage woes in the healthcare industry. Healthcare providers often find themselves negotiating with insurance companies to secure fair reimbursement for their services. These negotiations can be complex and arduous, with both parties seeking to protect their interests and balance the needs of patients.
It is crucial for healthcare providers and insurance companies to find common ground and work towards a solution that benefits all stakeholders involved. The ultimate goal should be to ensure that patients have access to necessary medical services without facing exorbitant costs.
In conclusion, the dispute between WellNow Urgent Care and Excellus BlueCross BlueShield over insurance rates sheds light on the challenges faced by both healthcare providers and insurance companies in navigating the complex landscape of healthcare coverage. Finding a fair and viable solution is essential to ensure the delivery of quality care while maintaining affordability for patients.
Which Rochester-area urgent cares can you go to with Excellus?
There are still several urgent care options available for Excellus-insured individuals in the Rochester area, even with the coverage change at WellNow.
If you’re a resident of Monroe County and are covered by Excellus BlueCross BlueShield, here are some urgent care options you can consider:
- Acute Kids Urgent Care locations in Greece and Webster
- Cornerstone Urgent Care on Chili Avenue in Rochester
- Pediatric Urgent Care of Rochester in Fairport
- Rochester Walk-In Care on Chili Avenue in Rochester
- RRH Urgent Care locations in Greece, Henrietta, St. Mary’s Campus, Webster and Wilson Center
- Unity Walk-In Care Center on Genesee Street in Rochester
- Urgent Care Now in Webster
- Urgent Care of Henrietta/Extended Medical Services
- UR Medicine Urgent Care in Greece, Henrietta, Penfield, Pittsford, Spencerport and Webster
- West End Pediatric Urgent Care on English Road in Rochester
Which insurances do WellNow urgent cares accept in NY?
In May, WellNow terminated its network affiliation with EmblemHealth due to inflationary pressures and the increasing cost of providing medical care.
In June, WellNow faced some challenges in the Capital Region. They had to make the tough decision to close three urgent care sites and delay the opening of four others. This was due to a combination of factors, including the expiration of federal pandemic aid, a decrease in demand for COVID-19 tests, and a shortage of healthcare workers across the country. The Times Union first reported on these developments.
WellNow accepts other insurance plans, including:
- Aetna Health/Meritain
- Anthem Blue Cross Blue Shield
- Blue Cross Blue Shield
- Capital District Physicians’ Health Plan (CDPHP)
- CDPHP Universal Benefits
- Cigna (with MVP or MultiPlan network logo)
- Empire BlueCross BlueShield (Anthem)
- Empire UnitedHealthCare
- Excellus BCBS- select regions in NY only
- Fidelis Care
- Highmark Northeastern New York
- Highmark Western New York
- Humana ChoiceCare Network
- Humana Military/TriCare
- Independent Health
- Lifetime Benefits Solutions
- Martin’s Point
- Med Priority
- Medicare Advantage Plans
- Medicare Part B
- Molina Healthcare
- MVP Health Plan
- MVP Select Care
- Nova Healthcare
- NYS Medicaid
- Pennsylvania Medicaid – Limited locations (Jamestown, Lakewood, Olean, Big Flats)
- Railroad Medicare
- TriCare East – Humana Military
- UMR – A UnitedHealthcare Company
- UnitedHealthcare Empire Plan
- Univera Healthcare
- UPMC Health Plan
- VA Community Care Network
- WellCare by Fidelis Care
- WellCare Today’s Options Medicare Advantage Plus
- Workers’ Comp and Employer First Aid
The report was contributed to by David Robinson, a team reporter for New York State.