Community Regional Medical Center in downtown Fresno is the largest hospital in the central San Joaquin Valley. The hospital’s owners, Community Health System, and several major insurance plans failed to reach agreement on new reimbursement contracts before they expired on Dec. 31, 2022. As a result, thousands of insurance plan members now face higher out-of-network costs for care from Community Regional and its sister hospital, Clovis Community Medical Center.
Fresno Bee file
Community Health System, which operates four local hospitals including Community Regional Medical Center in downtown Fresno and Clovis Community Medical Center in Clovis, has reached an agreement with United Healthcare, one of three insurance providers whose contracts for in-network coverage expired at the end of 2022.
“We’re pleased to have reached an agreement with United Healthcare,” said Aldo De La Torre, senior vice president, network development and insurance services at Community Health System. “The terms will be retroactive to Jan. 1, and therefore no lapse in coverage for those with United Healthcare insurance plans.”
It continues to renegotiate expired contracts with Anthem Blue Cross and Cigna, Community says in a statement on its website. It has commercial health plan agreements with Aetna, Blue Shield of California, Community Care Health, Health Net/CalViva, Health Smart, Humana, Multi-Plan and, again, United Healthcare.
A Community statement says: “We will continue to ask health plans whose contracts expired to join us in reaching a fair and reasonable agreement and to acknowledge the unprecedented cost increases for delivering care.”
Medical care at Community Regional, Clovis Community, Fresno Heart & Surgical Hospital and other associated clinics became out-of-network for people insured by United Healthcare when its contract expired on Dec. 31, 2022, along with Anthem Blue Cross and Cigna.
Members faced higher out-of-pocket costs for treatment because the hospitals were no longer within their network, paying out-of-network rates or even full cost for treatment at Community’s hospitals. Insurers cover a much larger share of medical bills incurred at in-network hospitals.
The Community Health System, which provides the majority of health care in Fresno County, gave no update on negotiations with Anthem Blue Cross or Cigna.
“Unfortunately, costs have risen steadily due to the impact of COVID-19 combined with extraordinary inflation,” it says in its statement on the United Healthcare agreement. “Added is the strain health systems are experiencing with wage inflation, labor shortages and the cost to fill positions with contracted labor at astronomical rates. Meanwhile, the demand for our health system’s services continues to grow.
“We remain fully committed to entering into fair and stable contract relationships with all commercial health plans that wish to do so.”
This story was originally published January 22, 2023 9:32 AM.
