Community, United Healthcare ink deal to resume hospital, doc coverage

Valley patients belonging to three major insurance groups have been unable to access Fresno County’s lone Trauma 1 hospital. Now, two remain.

Less than one month after patients carrying its insurance were turned away from Community medical centers and its partner doctors, United Healthcare customers can now resume accessing the Fresno-based health care facilities, Community Health System announced Saturday.

Community, which operates four hospitals including Community Regional Medical Center in downtown Fresno and Clovis Community Medical Center, has seen three insurance deals – Anthem Blue Cross, Cigna, and United Healthcare – expire at the end of 2022 as negotiations continued.

Go deeper: Much of the battling between the hospital group and insurers centers on the growing chasm of reimbursement rates for services.

  • The hospital group has pointed to increased costs during the coronavirus pandemic, inflationary pressures, and increased labor costs on on-going operations of the two hospitals.

What they’re saying: “We’re pleased to have reached an agreement with United Healthcare. The terms will be retro-active to January 1, and therefore no lapse in coverage for those with United Healthcare insurance plans,” said Aldo De La Torre, Community  senior vice president of network development & insurance services.

  • “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. While the vast majority of contract negotiations are successful, it is not uncommon for agreements to expire. Going out of network is new territory for us as a health system, but it is very common in the industry throughout California,” the hospital group said, announcing the contract extension.

Looking ahead: The hospital is still negotiating a deal with the area’s largest private insurer, Anthem Blue Cross, and Cigna.

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