Provider Contract Updates | News | Excellus BlueCross BlueShield (original) (raw)
Members: Excellus BlueCross BlueShield has executed a new provider contract agreement with WellNow Urgent Care and is in active contract discussions with FamilyCare Medical Group and St. Joseph's Health.
You may have recently heard about contract discussions between health care providers and health insurers, and how it may affect you. We want to help you understand how the contracting process works and how we consider the needs of providers and members throughout these discussions.
Why You’re Hearing More About Contract Discussions
It is becoming more common for you to hear about contract discussions than in the past. Providers are more likely to notify you and the media about the possibility of going out of network while contract discussions are ongoing, and an agreement may still be reached. Locally and nationally, more providers are using public pressure as a negotiation tactic.
What to Know
Contract discussions between health insurers and health care providers are a normal process that happens every year, or every few years. These conversations are generally kept private because we almost always reach an agreement, and we don’t want to cause unnecessary stress or confusion for our members.
Please know that we approach these discussions in good faith, striving to reach an agreement that is fair for all parties involved. It is our priority to ensure that the providers you trust remain within our strong network, which includes 98 percent of local providers.
Serving as Your Advocate
During these discussions, some providers may request much higher payments. While we support our doctors and hospitals, especially as they face rising healthcare costs, we also prioritize keeping your care as affordable as possible. Higher payments to providers can result in increased premium rates for you.
We aim to strike a balance that allows us to continue providing access to high-quality care that’s as affordable as possible, while also paying your providers a fair rate. As a local, nonprofit health plan, we invest nearly every premium dollar into care for our members, including hospital and doctor visits and medication.
In 2023, 93 cents of every premium dollar collected went toward medical care for our members.
We know hearing about contract negotiations can be stressful. We've created a quick guide with key facts and more.
Frequently Asked Questions
What does it mean when a provider leaves the Excellus BCBS provider network?
If a provider leaves our network, they will become an out-of-network provider. This means that you will pay more for out-of-network care. You may have benefits that cover some of the costs. Coverage varies based on benefits. You can log in to your online account or Excellus BCBS mobile app to view your plan coverage or call Customer Care, using the phone number on the back of your member card.
What if I need emergency medical care at an out-of-network hospital?
You should always seek emergency care if you believe you are experiencing a medical emergency at the closest location to you. If you go to an out-of-network hospital to receive emergency medical care, this will be considered in-network.
Some patients, including those who are pregnant or undergoing active treatment for cancer or a chronic condition, may qualify for extended in-network access through Excellus BCBS's Continuity of Care program. That means you can continue to receive care from the out-of-network provider at the in-network rate for a certain period of time.
- Please call Customer Care, using the phone number on the back of your member card, to see if you qualify, and to get instructions on how to continue to receive care based on your health plan.
- If you have insurance through your employer, contact your HR or benefits manager on coverage details.
- If your Continuity of Care request is approved, you will have in-network access to your current health care provider for a certain period of time.
If an agreement with the hospital isn't reached and the contract terminates (for example, on December 31, 2024), your in-network benefits would remain in effect for an additional 60 days. This additional 60-day period is called the "cooling off period." You would pay the in-network rate for hospital services during this period.
Under New York state law, this "cooling off period" does not apply to physician practices, which includes those practices that are affiliated with hospitals. Once the hospital contract ends, you would pay the out-of-network rate for care at the affiliated physician practices.
We understand some patients may have appointments scheduled on or after a termination date. If this is the case, you should call Customer Care, using the phone number on the back of your member card, to determine whether your procedure will be covered through Continuity of Care provisions.
What is the difference between in-network and out-of-network?
When you go to a healthcare provider that is "out-of-network," it means they don't accept your insurance. This usually means you'll have to pay more for the same services compared to using an "in-network" provider, who does accept your insurance.
Different insurance plans have different rules. Some cover out-of-network care, while others only cover it in emergencies, like if you have to go to the emergency room while traveling.
Learn how the difference between in-network and out-of-network care may impact your health costs.
What if I have more questions?
Log in to your online account or Excellus BCBS mobile app to view your benefits and coverage.
If you need urgent or emergency care, learn more on our Care Options page.
For all other questions or help finding an in-network doctor or hospital, please call Customer Care at 1-877-883-9577 (TTY 711), Monday through Friday from 8 a.m. to 8 p.m.