Cigna Healthcare and Community Health System are in contract negotiations ahead of a June 30 deadline. If no deal is reached, facilities including Community Regional Medical Center will leave Cigna’s network July 1. (Image composite by The Business Journal)
Community Health System has resolved its months-long contract dispute with Blue Shield of California, but a new standoff with Cigna Healthcare threatens to disrupt care for Fresno-area patients starting July 1.
Community officials announced Tuesday they reached a new multi-year agreement with Blue Shield that retroactively restores in-network access to Feb. 1 for Blue Shield members at all Community facilities and affiliated physician groups. The deal ends a months-long period that left thousands of local patients out-of-network.
Even as Blue Shield patients regain coverage, a similar dispute is building for Cigna policyholders.
New deadline for Cigna members
According to Cigna notices sent to policyholders, Cigna and Community — operating under its corporate name, Community Medical Centers — are in contract negotiations. If no agreement is reached by June 30, the hospital system will leave Cigna’s commercial network July 1.
The change would affect Community facilities including Community Regional Medical Center, Clovis Community Medical Center and Fresno Heart & Surgical Hospital.
In letters to patients, Cigna said the hospital network is “demanding higher-than-average prices” that would raise health care costs.
Community officials have said higher commercial reimbursement rates are necessary to offset rising labor, pharmaceutical and operating costs, and that Medicare and Medi-Cal patients make up the bulk of its patient volume.
Cigna said in its correspondence to patients that it will “keep talking to Community Medical Centers to try to reach an agreement.”
The patient impact
Bryan Esparza, a Fresno resident and Cigna policyholder, recently received a letter warning he may need to find a new primary care provider. Esparza said losing access to Community Medical Centers would mean leaving a doctor who knows his family’s medical history.
“Health care isn’t just about a building, it’s about the relationships and trust we build with our providers,” Esparza said. “It disrupts our continuity of care and forces us to start completely over, which is stressful and entirely unfair to patients.”
What happens July 1 if no deal is reached
Emergency care: By law, emergency services at Community hospitals remain covered at in-network rates until a patient is stable, regardless of contract status.
Alternative providers: Cigna has begun directing patients to in-network facilities including St. Agnes Medical Center in Fresno — about 2 to 7 miles from Community facilities, depending on location — and Adventist Health facilities in Selma and Reedley, roughly 16 to 26 miles away.
Continuity of care: Patients in active treatment, such as pregnancy or chronic illness care, can apply for a Continuity of Care waiver. Coverage at in-network rates can continue for up to 90 days starting from the date Cigna’s notice was postmarked.
Community resolved its dispute with Blue Shield close to deadline. Whether it can do the same with Cigna remains unclear, with days left before the contract lapses.