Dispute Over Reimbursement Rates: Impact on Excellus BlueCross BlueShield Insurance Holders

Dispute Over Reimbursement Rates: Impact on Excellus BlueCross BlueShield Insurance Holders

Discover how a disagreement over reimbursement rates between WellNow and Excellus BlueCross BlueShield could affect insurance holders in the Rochester, N.Y. area. Find out the potential out-of-pocket costs, concerns about limited care choices, and the ongoing contract discussions between the two parties.

The Reimbursement Rate Dispute

WellNow and Excellus BlueCross BlueShield are currently locked in a dispute over reimbursement rates. WellNow, a healthcare provider in the Rochester, N.Y. area, is requesting higher rates from Excellus to ensure fair and adequate reimbursement for their services.

Dispute Over Reimbursement Rates: Impact on Excellus BlueCross BlueShield Insurance Holders - -1673205745

Dr. Biernbaum, the chief medical officer for WellNow, has expressed concerns that despite insurance rates increasing annually, they are being reimbursed less than before. This discrepancy has led to negotiations between the two parties, with WellNow requesting a more than 60 percent increase in reimbursement rates.

If an agreement is not reached by January 1, 2024, WellNow has stated that they will no longer accept Excellus insurance. This potential outcome could have a significant impact on hundreds of thousands of patients who rely on WellNow for their healthcare needs.

Potential Out-of-Pocket Costs

If the reimbursement rate dispute between WellNow and Excellus is not resolved, Excellus insurance holders may face higher out-of-pocket costs for their healthcare services. WellNow has stated that patients could potentially pay up to $165 out-of-pocket for care if an agreement is not reached.

This increase in costs could put a strain on individuals and families who rely on their insurance coverage to manage their healthcare expenses. It is important for insurance holders to stay informed about the ongoing negotiations and potential impact on their out-of-pocket costs.

Concerns About Limited Care Choices

The dispute over reimbursement rates between WellNow and Excellus has raised concerns about limited care choices for patients in the Rochester, N.Y. area. If WellNow stops accepting Excellus insurance, hundreds of thousands of patients may need to seek alternative healthcare providers.

NYS Assemblywoman Sarah Clark has voiced her concerns about the potential impact on patients’ access to care. It is important for patients to be aware of the options available to them and to stay informed about any changes in healthcare provider networks.

Ongoing Contract Discussions

Excellus BlueCross BlueShield has confirmed that they are engaged in ongoing contract discussions with WellNow. These discussions aim to resolve the reimbursement rate dispute and ensure that patients continue to have access to the healthcare services they need.

Excellus has stated that WellNow has requested a more than 60 percent increase in reimbursement rates, which they consider significantly higher than what local providers receive for similar services. Both parties are working towards finding a mutually beneficial agreement.

It is important for insurance holders to stay informed about the progress of these contract discussions and any potential changes that may affect their healthcare coverage.

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