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An important notice to our Highmark Blue Cross Blue Shield of Western New York members

  • You may have heard that Highmark Blue Cross Blue Shield of Western New York is currently engaged in contract negotiations with Catholic Health.

  • Naturally, this may raise questions about your coverage and care.

  • Rest assured that your health care coverage will continue uninterrupted during these negotiations. State law requires that will be the case through at least Feb. 28, 2023, despite what you may hear from Catholic Health directly.

  • Highmark BCBSWNY is working hard to reach contract terms that are acceptable to Catholic Health and fair to the members and communities we serve, like we have with other hospitals in Western New York.

  • Most recently, we reached a new long-term agreement with Kaleida Health, the largest healthcare provider in Western New York. 

  • Similar to other agreements, Highmark's proposed terms would increase compensation and reimbursement to the dedicated health care professionals who keep our community healthy. 

  • Unfortunately, Catholic Health’s requests far exceed what other hospitals in the region requested.

  • We want to keep Catholic Health in our network, but we must protect our members from excessive increases that could put health care out of reach for many.

  • Please know that we remain committed to providing access to affordable, high-quality care for our members across Western New York. That’s why we will continue to work in good faith to keep Catholic Health hospitals in our network, without having to pass on significant costs to our members. 

  • Get updates from us right here at: bcbswny.com/CHSfacts

A Word From Our Senior Medical Director, Dr. Mark Perry

Frequently Asked Questions (FAQs)

What is happening between Highmark Blue Cross Blue Shield of Western New York and Catholic Health?

For several months, Highmark Blue Cross Blue Shield of Western New York has been negotiating in good faith to reach a new agreement with Catholic Health. These types of discussions typically happen behind the scenes and are a normal part of our business practices.

However, given an unnecessary public campaign launched by Catholic Health, we have been forced to address these ongoing negotiations with our members.

Why has an agreement not been reached yet?

Highmark BCBSWNY is working hard to reach contract terms that are acceptable to Catholic Health and fair to the members and communities we serve, like we have with other hospitals in Western New York.

Most recently, we reached a new long-term agreement with Kaleida Health, the largest healthcare provider in Western New York.

Similar to other agreements, Highmark’s proposed terms would increase compensation and reimbursement to the dedicated health care professionals who keep our community healthy.

Unfortunately, Catholic Health’s requests far exceed what other hospitals in the region requested.

We want to keep Catholic Health in our network, but we must protect our members from excessive increases that could put health care out of reach for many. 

Will my care be disrupted?

During these negotiations, and through at least Feb. 28, 2023, you will continue to have access to the Catholic Health System.

Assuming an agreement is not reached, Highmark BCBSWNY members would maintain coverage at Catholic Health hospitals through a mandated “cooling off” period, which extends until Feb. 28, 2023. 

Members in an ongoing course of care are entitled to an additional 30 days of access, until April 1, 2023.

If an agreement can’t be reached, will I lose coverage to my doctor?

Your Catholic Medical Partners doctors and health care providers remain in-network. These talks only involve Catholic Health’s hospitals and other facilities, such as skilled nursing facilities and ambulatory surgery centers. We have separate agreements with your primary care and specialty doctors, so access to these doctors should not be interrupted. In the unlikely event an agreement with Catholic Health hospitals cannot be reached, we’ll work to have your doctors refer you to other in-network hospitals in the area.

What should members do right now? 

There is still adequate negotiating time remaining to reach a new agreement, we are working hard on your behalf. There is nothing our members need to do right now, but if you would like to explore other in network options a full list of in-network hospitals can be found at the website on the back of your member ID card. You can view a shorter list by navigating to the “other in-network hospitals” section of the FAQ. 

We remain confident we’ll reach an agreement, hopefully very soon, but well in advance of Feb. 28, which is the date state law says all coverage remains in place.

You recently received rate increases for small group and individual products. Shouldn’t this help cover what Catholic Health is requesting?

First, our small group and individual products are approved by New York State and represent 15% of our total membership in Western New York. 

And we anticipate that the premium increases for these members next year are not enough to even cover the costs of their care. 

As has been the case over the last several years, these losses will need to be subsidized by the other 85% of our membership. This situation would get even worse if Catholic Health’s demands for double-digit payment increases were met.

Does this impact Medicaid members?

No, Medicaid members are covered under a separate agreement with Catholic Health.

I’m a Medicare Advantage member and I’m worried about losing access to Catholic Health hospitals after the Annual Enrollment Period, what should I do?

Medicare Advantage members who are happy in their current plan do not need to do anything. You will continue to have access to Catholic Health hospitals and facilities through February 28, 2023. If an agreement cannot be reached by February 28, 2023, You will have an opportunity to switch plans during the Medicare Advantage Open Enrollment period from January 1 through March 31, 2023. During this time, Medicare Advantage members can make a one-time switch to a different Medicare Advantage Plan. 

What should I do if I have questions about how this impacts my care?

If you have specific questions about your care, call the number on the back of your Highmark BCBSWNY card. Our Member Service team is here to answer your questions and help you feel confident that you can continue to receive the care you need as a Highmark member. You can also visit bcbswny.com/CHSfacts for a list of frequently asked questions and to get updates on the status of the negotiation.

What are the Catholic Health facilities?

Catholic Health consists of the following facilities: 

  • AthletiCare – Kenmore Mercy
  • Father Baker Manor
  • Kenmore Mercy Hospital
  • McAuley Residence
  • McAuley-Seton Home Care
  • Mercy Home Care of WNY
  • Mercy Hospital of Buffalo
  • Mount St. Mary’s Hospital • Rochester Pathways
  • Sisters Health Center
  • Sisters of Charity Hospital
  • Sisters of Charity Hospital – St. Joseph Campus
  • St. Catherine Laboure Health Center
  • St. Vincent Health Center
  • STAR St. Vincent
  • Sterling Surgical Center
     

How might this affect me?

Highmark BCBSWNY’s contract with Catholic Health expires December 31, 2022, but your coverage will remain uninterrupted through at least February 28, 2023.

Assuming no agreement is reached prior, from January 1, 2023, through February 28, 2023 (a mandated 60-day period of compliance with our contract), you will continue to be able to receive care from any Catholic Health facility.

For updates on these negotiations, visit our website at bcbswny.com/CHSFacts.

The following pages include information on what you can do if a contract is not reached before March 1, 2023. 

What happens if a contract cannot be reached?

If no contract is reached before March 1, 2023, only the following services will be covered as in network at Catholic Health hospitals:

  • Cases of emergency
  • If no in-network provider can deliver the services required
  • If a network hospital is not available within a 30-mile radius of your home
  • For any services that were previously authorized by us
  • For transitional care of ongoing treatment
  • For women who are in the second trimester of pregnancy or later (transitional period will extend through postpartum care directly related to the delivery)

For any other circumstances, your care at Catholic Health will be considered out of network.

If you are currently receiving services from Catholic Health or are scheduled for treatment at their hospitals, please contact our customer service team by calling the number on the back of your member ID card.

What if a contract is not reached and I receive care at Catholic Health after March 1, 2023?

You may be refused treatment for elective or nonemergency care at Catholic Health hospitals.

Catholic Health hospitals will not be able to refuse emergency treatment to you but, once stabilized, you may be transferred to another hospital.

Catholic Health will no longer bill Highmark Blue Cross Blue Shield directly, so you may be responsible for filing claims with us to obtain reimbursement.

You may be required to pay for services upfront before Catholic Health treats you.

A full list of in-network hospitals can be found at the website on the back of your member ID card, or you can view a shorter list below.

Other in-network hospitals:

If an agreement can’t be reached, will Medigap (Medicare Supplement) members be impacted?

  • No, Medigap members can receive care with any provider that accepts Medicare coverage.

  • In the unlikely event an agreement cannot be reached, your coverage at Catholic Health would be unaffected.

What if I have more questions?

Please continue to check back regularly for more updates or call the number on the back of your member ID card.