Fresno City Hall photo by Breanna Hardy

A reported 1,500 City of Fresno employees are among those affected by an unresolved contract dispute between Blue Shield of California and Community Health System that has left workers without in-network access to Community facilities.

Councilmember Annalisa Perea on Thursday called on Blue Shield and Community Medical Centers to “act with urgency and good faith” to reach an immediate agreement, after City employees lost in-network coverage to Community facilities when their contract expired Jan. 31.

“Our workforce should never be placed in the middle of negotiations that directly impact their health, their families, and their financial stability,” Perea said in a statement. “Healthcare is not a bargaining chip. It is essential.”

City employees who are regularly seen at Community Regional or Clovis Community must now seek care at out-of-network rates or find new providers at facilities like St. Agnes Medical Center or Valley Children’s Hospital, ABC30 reported.

Dispute over performance metrics

Part of the breakdown between Blue Shield and Community stems from disagreements over contract terms, with both sides offering different accounts of the impasse.

In a statement issued last week, Blue Shield said it had offered “fair and reasonable rate increases” along with additional payments tied to quality outcomes and care performance, but said Community was unwilling to accept performance-based compensation.

“CMC is not willing to tie any portion of their pay increases to performance, which is not in the best interest of our members,” Blue Shield said.

Community pushed back on that characterization, saying the contract expired Jan. 31 after Blue Shield declined to grant an extension while negotiations continued.

“All healthcare provider contracts have an expiration date with an opportunity to extend the contract while in negotiations,” Community said in a statement. “Blue Shield did not grant the extension and let it expire January 31, 2026. We are actively negotiating with Blue Shield and working to reach an equitable agreement as soon as possible so we can continue providing quality healthcare to those who rely on us.”

In a statement from Aldo De La Torre, division president of Insurance Services & Managed Care at Community Health System, the hospital said it already participates in performance-based programs with other insurers.

“Community actively participates in performance-based quality programs with many of our contracted health plan partners and shares the goal of improving outcomes,” De La Torre said. “Our ability to provide high-quality, accessible care for our patients depends on contracts that fairly reimburse our care teams for the services they deliver. We remain ready to negotiate so we can reach an agreement that preserves access for all Blue Shield members in our region.”

Both sides say they are continuing to negotiate, but there is no timeline for when they might reach a new agreement. The City of Fresno’s health and welfare board will hold a special meeting in March if the two parties do not come to an agreement by then to try to find alternate solutions, ABC30 reported.