At Excellus BlueCross BlueShield, we are in contract discussions with St. Joseph's Health (Trinity Health) in Central New York. St. Joseph's Health has notified us that they will leave our provider network if a new contract isn't agreed upon by Dec. 31, 2024.
We have been meeting regularly with St. Joseph's Health to work towards a mutually agreed upon provider contract. We believe that progress has been made and feel optimistic that we are on a track to resolution.
We want you to know that these types of contract discussions are normal for this time of year, and it's common for these conversations to continue well into the fourth quarter before a new contract is mutually agreed upon.
While most of these discussions between insurers and providers occur privately, some can become public. It's becoming more common for you to hear about contract discussions than in the past. You'll likely continue to hear about these discussions as more doctors and hospitals locally and nationwide use public pressure as a negotiation tactic.
Our Goal: Keep St. Joseph's In Our Network
We are working to reach an agreement that keeps St. Joseph's in our network.
We know you value the care you receive from your doctor and hospital. Hearing that they may choose to leave your insurer’s network can be confusing and stressful. We want to reassure you that our goal is to keep St. Joseph’s in our strong network, which includes 98 percent of all local providers.
Our priority is to come to an agreement by the end of the year, and we remain committed to these ongoing negotiations.
Your Coverage For An Out-Of-Network Hospital
However, if St. Joseph's chooses to leave our network, they'll become the only out-of-network hospital in our service area. You can still receive care from out-of-network doctors and hospitals, but you'll usually have to pay more.
If St. Joseph's leaves our network, there are certain circumstances in which you will still be able to receive care from them at the in-network rate, which will cost you less. Here are some of those circumstances:
- You can continue to receive emergency medical care from St. Joseph’s at the in-network rate.
- Your in-network benefits would remain in effect for St. Joseph’s Health’s hospital for an additional 60 days starting on the termination date of January 1, 2025. This additional 60-day period is called the "cooling off period." You would pay the in-network rate for hospital services during this period.
Please note: 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 may also qualify for "continuity of care" coverage if you are pregnant or undergoing active treatment for cancer or a chronic condition. If you qualify for this coverage, you will receive extended in-network access for a certain period of time.
- Please visit our Frequently Asked Questions for more details on which services are covered as in-network.
An Unprecedented Rate Request That Impacts You
During contract discussions, St. Joseph's asked for unprecedented, double-digit rate increases. As your locally based, non-profit health plan, we don't think that's fair to you.
If we agreed to their rate request, you could have to pay more for your coverage. We can't accept this request in good faith, especially as health care costs continue to rise. Our team is working hard to reach a fair contract with St. Joseph's that preserves in-network access to your doctors and hospitals without substantially raising your health care costs.
When We Pay More, You Pay More
Approving St. Joseph's current rate increase request would result in more than tens of millions of dollars in additional health care costs for our Central New York communities, placing an even greater financial strain on our members and employers. We know many in Central New York are already suffering from rising costs that range from food and rent to health care.
We're part of our local communities. We live here and we work here. We have a proven track record of investing in our local doctors and communities. We offered St. Joseph's an overall rate increase that we firmly believe is reasonable considering the cost pressures faced by our providers, members and employers.
Correcting False Claims
In their communications, St. Joseph's has started to cause worry, while also misrepresenting the facts surrounding claims denials and untimely payments. These topics of concern were surprising to us because they had not been raised during our negotiations.
We don't know why the health system referenced these items. Here's how we've partnered with St Joseph's:
- We provide a cash advance of several millions of dollars to St. Joseph's to ensure they don't have to wait for reimbursement from us to cover the costs associated with treating our members. This is a rare practice among health plans, but we do this to support our local health systems.
- To say we delay payments is inaccurate. We're in full compliance with New York state law that requires us to pay claims within a certain time period.
- About 95 percent of insurance claims from St. Joseph's in 2024 were approved and processed within 10 days.
Why it Matters
As an example, let's look at how much prices for certain services could increase on average if we accepted a 16 percent rate increase each year over three years for St. Joseph's Health; see graphic.
Price increases could impact you in different ways:
- You could end up paying more for your health insurance since the cost of care has increased.
- Or you could pay more for care when you go to the doctor or hospital, depending on the types of benefits you have.
What Happens Next
We understand this impacts your experience as our member. At this time, you don't need to take any action. We will communicate further updates as they develop.
It's our priority to come to a mutually agreed upon contract with St. Joseph's by year end.
We appreciate your membership and hope to continue to serve your health care needs. Thank you for trusting us with your care.
Contact:
If you have questions about your benefits and coverage, or other concerns, please log in to your online account or the Excellus BCBS mobile app, or call Customer Care at the number listed on the back of your member card. Additional information can be found on Provider Contract Updates, along with answers to frequently asked questions.
Excellus BlueCross BlueShield, an independent licensee of the Blue Cross Blue Shield Association, is a nonprofit health plan with 1.5 million upstate New York members. The company's mission is to help people live healthier and more secure lives through access to high-quality, affordable health care. Its products and services include cost-saving prescription drug discounts, wellness tracking tools and access to telemedicine. With about 4,500 employees, the company is committed to attracting and retaining a diverse workforce to foster innovation and better serve its members. It also encourages employees to engage in their communities by providing paid volunteer time off as one of many benefits. To learn more, visit ExcellusBCBS.com.
