We believe the best way to continue serving our community is to remain financially viable and reinvest in the delivery of care locally. Community Health System (Community) remains fully committed to fair and stable contract relationships with all our health plan partners that wish to do so.

Contracts with health plans are agreed to for a specific period of time. When that time is close to ending, we enter a negotiation period with the health plan. We have a few health plans that are set to expire at the end of this calendar year.

Our goal with health plans is to agree to a reimbursement rate that covers our ever-increasing cost of providing care. We want to ensure patients continue to have access to local healthcare providers.
 

Community has contracts with multiple health plans. For the most current list of contracts, please visit our website at communitymedical.org/contractstatus.

 

If you have questions regarding your health plan’s contract status, please contact your employer’s HR department or insurance broker for specific information regarding all health plans that are available to you.

Yes. Our biggest concern during negotiations is that patient care is not disrupted. During negotiations, please continue to schedule appointments, and receive care as usual with your healthcare provider.

We are working diligently to avoid going out of network as we understand the disruption that causes.

Community Medical Centers will continue to welcome all Aetna patients. Our goal is for our patients not to be affected as we work through this process with Aetna. We will honor the previous Aetna in-network out of pockets expenses for all services and care at our facilities so that patients and their families will not experience a disruption in care.

As Community negotiates in good faith, we must 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.

 

While health plans have the option of passing annual cost increases along to their members, hospitals do not and must work with previously contracted reimbursement rates until the commercial health plan agreements come up for renewal.

Community Regional Medical Center, Clovis Community Medical Center, Fresno Heart & Surgical Hospital, and Community Behavioral Health Center.

We will continue to keep our webpage updated on the status of our negotiations. Please check back at communitymedical.org/contractstatus for up-to-date information.

If an agreement is not reached, health plans typically send notices to their members within 5 days after the contract terminates, unless the contract is extended, or an agreement is reached.

 

Sometimes these notification letters are sent early, which is a routine part of the notification process. Most of the time, negotiations are successful and agreements are reached.

 

If an agreement isn’t reached, you may be able to continue care with a terminated provider in certain circumstances, such as chronic conditions, terminal illness, or scheduled surgery. This is called completion of covered services or continuity of care, and you should be advised of this option through a notice from your health plan.

Community will continue to welcome patients with a PPO health plan and honor the in-network rates for all services and care at our facilities. This means that your out-of-pocket costs should not be more than the PPO in-network amounts for services and care. We will work with you to address any financial implications when accessing care at our hospitals and provider offices.

During negotiations, you can continue to schedule appointments and receive care as usual from your provider. However, if an agreement is not reached, you may be reassigned by the HMO plan to a new Primary Care Physician (PCP), and they will send you a new membership card. If you are reassigned to a new PCP, you will likely be required to coordinate your ongoing health care needs with your new provider, as well as any referral and authorization requests.

Community Health System is proud to be locally owned and the region’s largest healthcare provider and private employer. Our health system includes Community Medical Centers’ four hospitals, which provide most of Fresno County’s hospital care and expertise typically found only in larger cities and a vast network of providers. In addition, Community Provider Network includes hundreds of affiliated primary and specialty care providers.