ROCHESTER, N.Y. – Starting on January 1, Excellus members can no longer visit a WellNow Urgent Care without paying a higher out-of-network price. It’s all about a protracted fight over the reimbursement rates that Excellus paid WellNow for its services. Let me remind you how we got here. Excellus leaders said WellNow should be billed at the rates offered to primary care providers. Wellnow executives say that’s far too low.

They don’t even understand what we do for the community,” said Dr. Robert Biernbaum, WellNow’s Chief Operating Officer. “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 leaders insist they negotiated in good faith. I asked a spokesperson for Excellus whether the insurer could restart negotiations with WellNow in the future or is this it She said, “For now, this is it.”

She points to the fact that you do have other options.  For example, there are about 20 other in-network urgent care facilities in Monroe County alone.  She has the following advice:

• She urges you to learn your primary care doctor’s after-hours resources.
• She reminds members that many plans have a telehealth option through Excellus.  Click here for those options. 
• She says you can also check the website for in-network urgent care options both in-person and telehealth.
• And lastly, she reminds members to use the emergency room only for severe injuries or illnesses.

As a consumer investigator, I also believe it’s important to get a price estimate before you go. Click here for the price estimator tool for URMC hospitals and here for those affiliated with Rochester Regional Health.