Independent Health drops Immediate Care from network

December 19, 2011 Updated Dec 19, 2011 at 9:34 AM EDT

By Business First by Tracey Drury, Buffalo Business First Reporter

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Independent Health drops Immediate Care from network

December 19, 2011 Updated Dec 19, 2011 at 9:34 AM EDT

BUFFALO, NY ( Business First ) Independent Health members will no longer be covered for care received at WNY Immediate Care urgent care centers, beginning in January.

The two companies were unable to come to a contract agreement on reimbursement rates, according to an announcement by the insurer. Members who opt to go to WNY Immediate Care sites will instead pay out-of-network fees equal to 20 percent of expenses, once they've met their deductibles.

Independent Health's action caught WNY Immediate Care officials by surprise.

It is with shock and regret that I read the IHA statement about the contract negotiations with WNY Immediate Care. Shocked because IHA's President, Dr. (Michael) Cropp, confirmed to me by letter on June 1, 2011 that IHA intended to continue its contract with Western New York Immediate Care through December 31, 2012, Joseph DiVincenzo, vice president, general counsel and compliance officer of WNY Immediate Care, said in statement released late Friday afternoon.

Without an agreement by Dec. 31, Immediate Care will be considered a non-participating provider for all lines of business. Members without out-of-network coverage would be responsible for the full balance.

According to Independent Health, WNY Immediate Care was asking for reimbursement rates of nearly twice the amount paid to the other 18 urgent care centers in the region.

All the remaining urgent care facilities in the community have accepted our community fee schedule in the past year, says Dr. Thomas Foels, chief medical officer at Independent Health.

These demands are unrealistic and unsustainable, in particular with the proliferation of similar centers throughout the region, and given the challenges we face as a region and nation to lower health care costs.

In his statement, DiVincenzo, challenged that.

"At no time has WNYIC requested any increases in the rates we agreed to and have accepted since 2005 despite yearly and significant increases in the premiums IHA has demanded of its subscribers during the same period," he said.

WNY Immediate Care, operated by the Exigence Group, has been in-network with the insurer since 2005. The organization operates five urgent care sites in the region, including a new site that opened in North Buffalo last month, its first within city limits.

About 5,000 Independent Health members sought care at WNY Immediate Care facilities last year, accounting for less than 2 percent of all members. Independent Health did not have total numbers for how many members were served at all urgent care facilities in the region.

The insurer says members will still have access to urgent care through their primary care physicians and other urgent care centers in the region, as well as the insurer's 24-hour medical help line.

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