Written by Alex Scott
This story has been updated to include a statement from United Healthcare.
Contracts between the Community Health System and two insurance giants end earlier this year as negotiations continue.
Community Medical Centers announced Thursday that its contractual agreement with Anthem Blue Cross would end on January 1, 2023 for the community’s network of hospitals and medical facilities. The point of contention is the flat-rate maintenance fee.
United Healthcare patients also received notification that coverage at Community Medical Centers will end on January 1, 2023. A representative from Community confirmed the notification.
As premiums for health plans rise, reimbursement rates have not caught up, according to a statement from Aldo De La Torre, senior vice president of development and insurance services at the Community Health System.
“Many healthcare plans continue to increase premiums – in some cases over 30% – and offer reimbursement increases to hospitals and other providers that don’t even come close to addressing our current rate of inflation, let alone the huge cost increases since the pandemic that still do plague hospitals, such as labor shortages and wage inflation, and astronomical increases in utility costs,” De La Torre said.
De La Torre said that under certain circumstances, for chronic illnesses, terminal illnesses and scheduled surgeries, care can be provided by patients who contact their insurance provider.
For its part, United Healthcare said they offered competitive rates to ensure hospitals were fairly compensated.
“Community Medical Centers is requesting an outrageous and unreasonable rate increase that would result in significantly higher healthcare costs for residents and employers in the Fresno area,” United Healthcare said in a statement.
Negotiations between Community Health and Anthem Blue Cross are ongoing. A statement from Anthem Blue Cross said these negotiations are standard practice in the industry and it is hoped that an agreement will be reached before the end of the year.
“We are currently in contract negotiations with Community Medical Centers as their existing contract agreements with Anthem Blue Cross expire at the end of this year,” said Michael Bowman, media liaison for Anthem Blue Cross, California. “It is important to note that Community Medical Center facilities remain within Anthem Blue Cross’s care networks. Contract talks like this are common in the healthcare industry. Anthem Blue Cross and Community Medical Centers have a long history of partnership and both remain committed to completing the discussion before the end of the year.”
Contract renegotiation is a common practice in the healthcare industry and is often based on multi-year agreements, but they are not all renewed at the same time.
“We have successfully renegotiated with some healthcare plans and are working diligently with others to ensure our patients continue to have access to our hospitals and clinics,” De La Torre said.
“Healthcare systems like Community simply need the health insurance plans to recognize the unprecedented cost challenges in caring for Central Valley residents and join us in making fair and reasonable arrangements,” De La Torre said.
The current contract contains provisions covering Members for continuity of care and delivery of Covered Services in the event of contract termination. A list of alternative participating hospitals in the area is as follows:
- Fresno Surgical Hospital
- Community Hospital Madera
- St Agnes Medical Center Fresno
- Community Hospital Selma
- Valley Children’s Hospital
Policyholders may be eligible for Transitional Assistance if they are pregnant, currently receiving treatment, or have a current healthcare services permit.
According to United Healthcare, the following centers would be available to policyholders.
- St Agnes Medical Center Fresno
- Madera Community Health
- Adventist Health Selma
- Adventist Health Reedley
- Adventist Health Hanford
Community encourages patients to contact their health insurance provider with questions about their contract status with Community.
“As we continue to negotiate in good faith, we ask the health plans to recognize the unprecedented cost challenges in caring for Central Valley residents and join us in reaching fair and equitable agreements,” De La Torre said.