CommercialCoverageHigh impact
Out-of-Network Services 11.01.13
Excellus BlueCross BlueShield·NY·Miscellaneous
Effective date
Jan 22, 2026
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield has updated their Out-of-Network Services policy (11.01.13) effective January 22, 2026, defining key terms and coverage requirements for when members receive care from non-participating providers. The policy clarifies emergency services, surprise billing protections, and out-of-network referral requirements including when services must be covered at in-network benefit levels.
Action Required
Before January 22, 2026: Billing team must review and update procedures for out-of-network service handling. Ensure staff understand when out-of-network referrals require coverage at in-network benefit levels, update surprise billing workflows to comply with new definitions, and verify emergency services are properly coded to avoid member surprise bills. Train front desk on obtaining explicit written consent for out-of-network referrals when required.