FRESNO, Calif. (KSEE/KGPE) – Thousands of Fresno city employees are losing in-network care at Community Medical Centers.
“It’s all employees, including retirees,” Fresno City Manager Georgeanne White said.
Five thousand city employees got a letter at the end of January, notifying them that Blue Shield of California’s contract with CRMC would expire Feb. 1.
Community Medical Center says the contract was originally supposed to expire at the end of 2025, but they agreed to a one-month extension.
“People can still go to those hospitals and go to those doctors, but they are going to have to pay a much higher level out-of-pocket costs,” White said.
Now that the contract’s expiration date has come and gone, White says 5,000 employees and their families are impacted.
“That could be anywhere from police officers, firefighters, bus drivers, solid waste drivers,” White listed.
She says patients do have options, though.
“For the city of Fresno, the other options are St. Agnes or Valley Children’s and any doctor that is outside of the community plan,” White said.
CRMC sent the following statement about the negotiations Friday.
“Community actively participates in performance-based quality programs with many of our contracted health plan partners and shares the goal of improving outcomes. 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. The amount tied to performance-based programs is not significant enough to cover costs of care. We look at each contract individually, however stagnant and declining government payments obviously impact our overall financial picture leaving us no wiggle room to accept a contract that doesn’t adequately cover the cost of providing care.”
Blue Shield also sent a statement, reminding patients they can request continued care if they are in active treatment.
“We know families and our customers are frustrated by the rising cost of health care – and they want to see solutions, not just explanations. We are willing to work with CMC to come to a solution that balances our shared responsibilities to provide access to quality, affordable care in San Joaquin Valley and throughout California.
It’s important to note that members do have access to Continuity of Care. If a member is receiving services for a course of treatment from a provider that is no longer in Blue Shield’s network, they may be eligible to continue receiving treatment from that provider under the same terms and conditions that applied before the contract termination date.”
White says this healthcare stand-off must end soon.
“We are encouraging Blue Shield and Community to come to a resolution. And if they have it by early March when we have called a special board meeting, then we’re going to have to talk about what some next steps could possibly be,” White said.
