Syracuse, NY -- Central New York’s only chain of urgent care centers and the region’s dominant health insurer are on the brink of a divorce that could affect thousands of patients.
If no agreement is reached by Dec. 31, Excellus Blue Cross Blue Shield clients will be forced to pay full price at WellNow Urgent Care facilities. Instead of a small co-pay, WellNow visits would cost an Excellus member a minimum of $165, not including specialty care, in the New Year.
The potential standoff pits two of the largest health care players in the region against each other. Their dispute threatens to send thousands more patients to Syracuse’s already overburdened emergency rooms and primary care doctors, an industry expert told Syracuse.com.
“WellNow is the safety value we count on,” said Tom Dennison, a retired Syracuse University professor and health expert.
The Illinois-based WellNow operates a dozen urgent care centers across Central New York. It is the only chain provider of standalone urgent care in the region. (Syracuse Community Health has a single walk-in center downtown.)
In 2022, Excellus members in Onondaga County made roughly 90,000 visits to WellNow facilities, the urgent care provider said. Across the state, Excellus members made 300,000 visits to WellNow.
Excellus is, by far, the area’s largest health insurance provider, Dennison noted. Locally, its accounts include employees of Syracuse University and Onondaga County government, among other major employers.
Onondaga County Executive Ryan McMahon scolded both Excellus and WellNow in a sharply worded letter Wednesday afternoon.
“...it will be the fault of BOTH parties, regardless of the rhetoric used to date by some, when the already overburdened hospital emergency rooms are inundated, when presently overcrowded physicians offices turn patients away; and when some are simply forced to go without care,” McMahon wrote in a letter posted on Facebook.
WellNow says that it can no longer afford to accept the payments Excellus is offering for services, arguing that the insurer’s payments were already low and haven’t kept up with inflation.
Excellus says that it pays WellNow for specific services at rates comparable to what it pays primary care providers for the same services. It says that WellNow’s demand for sharp payment increases are unreasonable.
“We believe in reimbursement rates that are fair and equitable, and fulfill our obligation to help keep health coverage as affordable as possible for our members while ensuring access to care,” the insurer said in a statement.
But WellNow argues that its services, such as late-night hours and X-ray capabilities, make its costs higher than a primary care provider.
“...our providers provide care oftentimes unavailable at a (primary care) office and to the community seven days a week, three hundred sixty-five days a year, with extended hours,” WellNow’s founder, Dr. John Radford, wrote the insurer in October.
Dennison said that there’s still time to work something out, despite the dire warnings by both sides.
“Usually, when it gets close to crunch time, there’s negotiation and there’s a settlement,” he said.
But that’s not always the case: St. Joseph’s Health and UnitedHealthcare remained at an impasse all summer before reaching a new agreement in October.
If nothing gets worked out between Excellus and WellNow, the stalemate could be “very disruptive” for emergency rooms at local hospitals, Dennison said.
“They’re all busy,” he said. “Everybody’s staffing is so tight. You can’t count on excess capacity.”
Those most affected will be WellNow’s target customer: someone without a life-threatening emergency. It’s those people who wait the longest at ERs, where others with true emergencies get care first.
“You can be sitting there for a very long time if people sicker than you need to be processed,” Dennison said.
WellNow has announced its intent to leave Excellus’s network Jan. 1, unless the health insurer agrees to higher rates.
Negotiations are continuing.
Staff writer Douglass Dowty can be reached at ddowty@syracuse.com or (315) 470-6070.