Community Regional Medical Center Image via CRMC Facebook page

This story was updated to include a statement from United Healthcare.

Contracts between Community Health System and a pair of insurance giants will end at the beginning of this year as negotiations continue.

Community Medical Centers announced Thursday its contract agreement with Anthem Blue Cross would end Jan. 1, 2023 for Community’s network of hospitals and medical facilities. At issue is reimbursement for care.

Patients with United Healthcare also received notice coverage with Community Medical Centers would end Jan. 1, 2023. A representative with Community confirmed the notice.

As health plan premiums increase, reimbursement rates have not caught up, according to a statement from Aldo De La Torre, senior vice president for development and insurance services with Community Health System.

“Many health plans continue to raise premiums—in some cases over 30%—while offering reimbursement increases to hospitals and other providers that do not even come close to addressing our current inflation rate, much less the enormous costs increases since the pandemic that continue to plague hospitals, such as labor shortages and wage inflation, and astronomical increases in supply costs,” De La Torre said.

De La Torre said in some circumstances for chronic conditions, terminal illness and scheduled surgery, care may be covered by patients who contact their insurance provider.

For its part, United Healthcare said they’ve offered market-competitive rates to ensure hospitals are fairly compensated.

“Community Medical Centers is demanding an egregious and unreasonable rate increase that would result in significantly higher health care costs for Fresno-area residents and employers,” a statement from United Healthcare read.

Negotiations between Community Health and Anthem Blue Cross are ongoing. A statement from Anthem Blue Cross said these negotiations are common practice in the industry and the hope is an agreement would be reached before the end of the year.

“We are currently in contract discussions with Community Medical Centers, as their existing contract agreements with Anthem Blue Cross are set to expire at the end of this year,” said Michael Bowman, media contact for Anthem Blue Cross, California. “It’s important to note that Community Medical Center facilities remain in Anthem Blue Cross’ care provider networks. Contract discussions such as these are common in the healthcare industry. Anthem Blue Cross and Community Medical Centers have a long history of partnership and both remain committed to bringing the discussion to a close before the end of the year.” 

Renegotiation of contracts is a common practice in the healthcare industry and often operates on multi-year agreements, however they do not all renew at the same time.

“We have been successful in renegotiating with some health plans and are working diligently with others to insure our patients continue to have access to our hospitals and clinics,” said De La Torre.

“Health care systems like Community simply need the health insurance plans to acknowledge the unprecedented cost challenges of delivering care to the residents of the Central Valley and join us in reaching fair and reasonable agreements,” said De La Torre.

The current contract has provisions that cover members for continuity of care and completion of covered services should the contract terminate. A list of alternative participating hospitals in the area are as follows:

• Fresno Surgical Hospital
• Madera Community Hospital
• Saint Agnes Medical Center Fresno
• Selma Community Hospital
• Valley Children’s Hospital

 

Policyholders may be eligible for transition assistance if they are pregnant, currently undergoing a course of treatment, or have a current authorization for healthcare services.

United Healthcare said the following centers would be available to policy holders.

• St. Agnes Medical Center Fresno
• Madera Community Health
• Adventist Health Selma
• Adventist Health Reedley
• Adventist Health Hanford

 

Community encourages patients to contact their health plans with any questions about the contract status with Community.

“As we continue to negotiate in good faith, we ask health plans to acknowledge the unprecedented cost challenges of delivering care to the residents of the Central Valley and join us in reaching fair and reasonable agreements,” said De La Torre.