FRESNO, Calif. – Fresno area patients are left with questions after a prominent hospital system and major health insurer parted ways earlier this month.
Healthcare giant Blue Shield of California and Community Health System terminated their contract on Feb. 1. Now, Community Health System facilities, including Fresno’s Community Regional Medical Center and Clovis Community Medical Hospital – known collectively as Community Medical Centers – are no longer considered in-network for patients insured by Blue Shield.
This affects specialty and emergency care for Blue Shield customers at these hospitals. It also affects primary and specialty care provided by a physician group known as Community Health Partners that is affiliated with the hospital system.
Neither company specified the number of patients affected by the dispute when contacted by KVPR. Blue Shield spokesperson Mark Seelig said the company insures a “meaningful” number of people in Fresno County and a small portion of Madera County.
KVPR employees are among those who received emails or letters about the contract termination in the days before it went into effect. According to GV Wire, roughly 1,500 employees of the City of Fresno also received letters.
Blue Shield and Community Health System point to each other for the disruption.
Seelig, the Blue Shield spokesperson, said the insurer has been negotiating with Community Health System “for many months.”
“We have provided [Community Medical Centers] a series of offers with fair and reasonable rate increases while protecting our members’ access to care,” he wrote in an email statement. “CMC is not willing to tie any portion of their pay increases to performance, which is not in the best interest of our members.”
In a statement, Aldo De La Torre, Community Health System's Division President of Insurance Services and Managed Care, wrote, “All healthcare provider contracts have an expiration date with an opportunity to extend the contract while in negotiations. Blue Shield did not grant the extension and let it expire January 31, 2026.”
Both companies say they continue negotiating in order to reach an agreement to continue services once again.
In the meantime, Blue Shield is recommending patients transfer to other in-network providers at St. Agnes Medical Center and Valley Children’s Hospital. Some patients with qualifying ongoing care – including maternity or postpartum care, and treatment for some chronic and terminal illnesses – can continue with their out-of-network providers under a Blue Shield provision known as “continuity of care.”
Both Blue Shield and Community Health System have published websites with information to address common concerns.
Blue Shield patients with questions can call the phone number listed on the back of their member identification card; CHS says its patients can call Community Patient Financial Services at (559) 459-3939 or 1-800-773-2223 ext. 53939.
