WellNow Urgent Care, Excellus BlueCross BlueShield clash over rates. Will patients suffer?

David Robinson, New York State Team
·4 min read
The WellNow Urgent Care in Ithaca is located between CoreLife Eatery and Chipotle. Its address is 740 South Meadow St.
The WellNow Urgent Care in Ithaca is located between CoreLife Eatery and Chipotle. Its address is 740 South Meadow St.

WellNow Urgent Care sites across upstate New York may soon become out-of-network for thousands of New Yorkers with Excellus BlueCross Blue Shield health insurance.

The coverage change would take effect Jan. 1 and impact WellNow's 75 urgent care locations, including more than two dozen sites in the Finger Lakes, Mohawk Valley and Southern Tier regions, according to a letter that the urgent care company sent Thursday to patients.

But WellNow also asserted the coverage change could be averted if Excellus raised the rates it paid to the urgent care chain. The health plan, which covers 1.5 million New Yorkers, countered in a statement that WellNow is seeking a rate increase that would exceed the rates paid for other local providers, adding negotiations are ongoing.

The WellNow and Excellus clash joined a growing list of prior rate showdowns between health providers and health plans, as the cost to provide medical care in New York keeps rising and the national health worker shortage fuels mounting crises inside the state's health system.

What WellNow says about Excellus rates

WellNow has asserted some of its urgent care sites could close in New York if health insurers refuse to increase rates for care.
WellNow has asserted some of its urgent care sites could close in New York if health insurers refuse to increase rates for care.

WellNow asserted the rate it gets from Excellus has been flat for the past decade.

"At the same time, over the past five years, Excellus ... has continued to drive average rate increases to their members of more than 8 percent every year, generating more than $130 million in profits a year," Wellnow's letter stated.

Health plans: New York health insurance rates to jump double-digit percentage in 2024

"Unfortunately, this isn’t sustainable," the letter added. "In fact, if we can’t agree on a fair pay rate from Excellus and other insurance carriers, there’s a real threat that some clinics in the communities we serve in New York will be forced to close."

WellNow noted it has 2,500 health care workers who could be impacted by any potential site closures. It previously ended its network affiliation with EmblemHealth in May, citing inflationary pressures and the rising cost to provide medical care.

In June, WellNow closed three urgent care sites and delayed opening four others in the Capital Region, citing in part the end of federal pandemic aid, reduced demand for COVID-19 tests and health worker shortages nationally, as first reported by the Times Union.

The urgent care industry has gone through several boom and bust cycles during the pandemic, in part, due to ever-evolving COVID-19 patient care demands and competition over workers. That included CityMD temporarily closing dozens of urgent cares across the Hudson Valley and New York City region in 2021.

What Excellus says about WellNow rate request

In response to USA TODAY Network questions, Excellus BlueCross BlueShield spokesperson Joy Auch asserted in a statement that WellNow's rate increase request "far exceed local primary care provider reimbursement." The health plan did not disclose the rate request.

"Given the fact that a majority of the services Wellnow provides to our members is primary care based, we do not think it’s fair to advantage WellNow over our local primary care providers who offer similar services in our communities," Excellus added.

The health plan noted over the past 20 years, its annual net income has averaged less than 2% of premium. In 2022, Excellus spent 91 cents of every premium dollar collected to pay its customers’ medical claims and activities that improve the quality of care, the statement added, noting Excellus is a locally-based nonprofit serving upstate New York and Wellnow is a Chicago-based for-profit company.

How much are health, insurance costs rising in NY?

Mar 24, 2023; Millwood, NY, USA; Gianluca Cefalo, 12, of Millwood, NY, pulls a syringe of insulin for use in an Omnipod 5 insulin pump. While the three largest makers of insulin have announced plans to slash prices, the cost of the medication is just one of many expenses people with diabetes must cover. A dispute between the families health insurer and the company that makes the pump leaves them with a monthly bill of $872 for his care. Mandatory Credit: John Meore-USA TODAY

In New York, the average insurance premium rates for individual plans have gone up a total of 31.4% from 2019 to 2023, with an average yearly increase of about 6%, according to a recent Health Plan Association report. For small group plans, that total increase was 30.6%.

  • Meanwhile, the price of health care services grew nearly 14% nationally from 2017 to 2021, while increasing more than 18% in New York, the report noted, citing the most recent comparative pricing data.

  • Next year, health insurance rates in New York for individuals will increase 12.4% on average next year while small-group plan rates rise 7.4%, state records show.

  • Meanwhile, New York’s health care system remains the costliest in the nation, spending about $14,000 per capita, according to the Kaiser Family Foundation. The national average is about $10,200 per capita.

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— David Robinson is a reporter on the state team for USA TODAY Network-New York and focuses on health. Reach him at drobinson@lohud.com or follow him @DRobinsonLoHud.

This article originally appeared on Rockland/Westchester Journal News: NY urgent care: Will WellNow cut Excellus from network? What we know