Anthem Blue Cross health care customers are in the middle of a tug-of-war between their insurance company and Community Medical Centers after an impasse in contract talks was declared.
Because of that impasse, Community Medical Centers has left Anthem’s care provider network. Except for emergencies and chronic care situations, Anthem customers will need to find a new physician or pay out-of-network rates to continue using their current doctors.
And they’re not the only ones — Community Medical says it also has been unable to reach agreement with Cigna and United Health Care, so Community Medical’s facilities and physicians are no longer in their provider networks as of Jan. 1.
Community Medical’s negotiations cover Community Regional Medical Center, Clovis Community Medical Center, Fresno Heart & Surgical Hospital, Community Behavioral Health Center, Community Subacute & Transitional Care Center, Community Home Health, and Community Health Partners.
Community Medical has “made progress” in negotiations with other health plans, said Aldo De La Torre, senior vice president for network development and insurance services. But “we have reached an unfortunate impasse in our negotiations with Anthem.”
According to Community Medical’s website, the company has renewed health care agreements with Aetna, Blue Shield of California, Community Care Health, Health Net, Health Smart, Humana, and Multi-Plan.
De La Torre said that Anthem’s rate increase offers are below inflationary levels and do “not account for increased costs of delivering care in our current, extremely challenging environment.”
Hospital spokeswoman Mary Lisa Russell provided a link to a website, Becker’s Payer Issues, showing that third-quarter profits for health plans were up for most providers at the same time that profits were in double-digit decreases for hospital companies.
For-Profit Health Plan
Community Medical contends that Anthem, a for-profit insurance company, is holding onto customer rate increases to boost its profit margin instead of providing additional compensation to care providers.
Anthem, meanwhile, says Community Medical’s proposals would cause rates to skyrocket for businesses and employees covered by the plan.
“Community Medical Centers insists on significantly raising prices for our members and customers. Agreeing to those terms would create a significant financial burden for families and businesses as a majority of those we serve are covered by self-funded plans — meaning they directly pay for their medical expenses,” Anthem said in a statement.
“Access to care is vitally important, and we are directing our members to seek other providers in our network to ensure they receive the quality and affordable care they need. We will continue working toward a favorable outcome with Community Medical Centers that enhances quality and protects affordability for those we serve.”
Might Not Have to Change Doctors
However, patients can file for a “continuity of care” to maintain their current physician. Patients who are pregnant, being treated for ongoing chronic illnesses, or have upcoming surgeries would need to request a continuity of care exemption from their health plan to continue coverage.