Urgent care provider threatens to sever ties with insurer over reimbursement rates

Urgent care provider threatens to sever ties with insurer over reimbursement rates | Insurance Business America

Life & Health

Urgent care provider threatens to sever ties with insurer over reimbursement rates

Insurer won’t commit to paying “reasonable rates,” healthcare provider says

Life & Health

By
Ryan Smith

One of the nation’s fastest-growing urgent care providers says it will sever ties with an insurer if it doesn’t get better reimbursement rates.

New York-based WellNow Urgent Care has announced that it will end its relationship with Excellus BlueCross BlueShield on Jan. 1 if the insurer doesn’t start paying “fair rates” for care provided.

“This action will effectively force WellNow Urgent Care locations to go ‘out-of-network’ with Excellus, impacting hundreds of thousands of Excellus covered patients who visit WellNow Urgent Care centers each year,” WellNow said in a news release.

The urgent care provider said it had been negotiating with Excellus “in good faith” since prior to the pandemic, but that the insurer had failed to commit to “reasonable rates” for healthcare services.

“In fact, rates from Excellus have decreased in the last decade despite the massive inflation over the last several years and the fact that Excellus has continued to raise rates for its members,” WellNow said.

The healthcare provider said it would be “unsustainable” to continue to do business with Excellus unless the insurer improved its rates.

“Excellus has been given permission by the New York Department of Financial Services to raise its premiums almost every year,” said Sam Meites, president of WellNow Urgent Care. “By our calculation, that’s more than an 8% increase in premiums each year for their customers since 2017. Yet, they don’t want to commit to reasonable rate increases that would help pay for the dedicated healthcare professionals who have worked proudly to meet New York’s urgent care needs. That’s Excellus placing pure profit over its members’ care.”

WellNow operates more than 70 urgent care clinics in New York state, including 41 centers in central New York.

With many regions in New York state lacking adequate access to healthcare and nearly 20 hospitals in the state’s rural areas at risk of closing, WellNow said urgent care clinics provide critical services for those living in so-called “healthcare deserts.” It is estimated that urgent care centers prevent more than 24 million emergency room visits each year, WellNow said.

“Unfortunately, Excellus is failing to meet the challenge to help New Yorkers close the gap between their healthcare needs and the region’s shrinking capacity,” Meites said. “Reimbursement rates must reflect the cost and value of services rendered, the convenience provided, and the cost savings to Excellus from providing a welcome alternative to already overburdened hospital emergency rooms. Fair reimbursement rates are not just a matter of financial stability for these centers – it directly impacts patients’ ability to access high-quality, cost-effective care in a timely manner throughout the state.”

BlueCross BlueShield is also facing a lawsuit in Tennessee by a group of former employees who were terminated for refusing to be vaccinated for COVID-19.

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