Provider Contract Updates
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, how we consider the needs of providers and members throughout these discussions, and what you need to know if we don’t reach an agreement.
About contract discussions with providers
We know hearing about contract discussions between health care providers and health insurers can be stressful. To answer questions you might have about this process, we've created a quick guideOpen a PDF with key facts and more.
Top things to know if a provider or hospital leaves our network
With 98 percent of local providers in our network, it’s very unusual for a doctor or hospital to leave our network. However, we want you to be prepared in case this does happen. Here are next steps to consider:
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.
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.
With Continuity of Care, some patients, including those who are pregnant or undergoing active treatment for cancer or a chronic condition, may qualify for extended in-network access. That means they can continue to receive care from the out-of-network provider at the in-network rate for a certain period of time. Excellus BCBS provides members with information on eligibility for continuity of care if their provider goes out of network. We encourage members to call the Customer Care phone number on the back of their member card if they need more information.
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.
You can find a list of providers who participate with your coverage using our Find a Doctor tool.
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.
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.
Latest Updates
Stay informed with the most recent updates on the following contract discussions:
