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Contract talks are heating up for Western New York health plans. See which providers might be affected and what it means for your coverage for the 2025 plan year.
Just in time for health insurance fall enrollment decisions, members of two Western New York plans are receiving notification about provider access they may lose next year.
Members of Independent Health were notified this week they may need to find a new pharmacy provider if negotiations with CVS aren’t finalized by year’s end. The letter cited “important potential changes.”
And last week, about 6,500 Highmark members received letters from Buffalo Medical Group about the possibility of losing in-network relationships that would affect care in 2025. The timing of the correspondence is key: Open enrollment for Medicare is Oct. 15 through Dec. 7 for 2025 coverage.
This type of communication often leads to worried phone calls between patients and providers, but contract negotiations usually work out in the end:
For Independent Health, the goal is to keep the lines of communication open for the 6% of its membership base who use CVS. Frank Sava, a spokesman for Independent Health, said the goal in all provider negotiations is to balance the financial position of its provider partners while ensuring access to affordable, high-quality health coverage for its members and employers.
“Unfortunately, CVS proposed new pricing that would raise member and plan costs significantly,” he said. “As a steward of our members’ premium dollars, we simply could not agree to these excessive costs.”
Highmark’s goal also is to keep BMG in its network, said Sarah Cotter, vice president, market executive for Highmark Blue Cross Blue Shield. In a prepared statement, she said the current agreement with BMG’s primary care providers and most specialists continues until July 1 and members can continue to see their doctors while negotiations continue with BMG and its for-profit partner, Agilon Health, the private equity partner that helps manage its Medicare Advantage program.
“As a not-for-profit health plan, our objective is to reach an agreement that would keep BMG in our network, at a price our members can afford,” she said. “We are continuing to meet frequently with Agilon and BMG and will keep our members updated as these conversations progress.”
BMG Medical Director Dr. John Notaro said the practice doesn’t want any patients to be surprised if the contract is not renewed.
“When it comes to our patients’ healthcare coverage, and the potential for disruptions, we believe that sharing updates, and facts, are a matter of responsibility, not a negotiating strategy,” he said.
Members insured in commercial group plans locally
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