The impasse between Blue Shield and Fresno’s Community Health System continues to drag on. For nearly three weeks, 12,000 enrollees have been unable to get in-network coverage.<\/p>\n
“Our only level one trauma center is right here in downtown Fresno, and the fact that we no longer have in-network coverage is a serious problem,” Fresno City Council President Mike Karbassi said on Thursday.<\/p>\n
Among those caught in the middle are 5,000 city employees.<\/p>\n
Blue Shield claims Community terminated the contract. But the healthcare system states the insurance company did not grant another extension.<\/p>\n
City leaders say it is time to cut Blue Shield out of the process and, instead, negotiate directly.<\/p>\n
“In situations like this, the Health and Welfare Trust can negotiate and work directly with a provider, in this case, Community Health Systems,” Karbassi said.<\/p>\n
This dispute comes just weeks after Community restored coverage for 6,000 Fresno Unified retirees on Aetna.<\/p>\n
Last month, Action News met Emily Brandt, who taught at Bullard High for 22 years.<\/p>\n
“I may look fine, but I don’t feel fine,” she told us.<\/p>\n
Brandt suffers from a rare form of cancer affecting three in a million people.<\/p>\n
Her appointments at Community were canceled after the lapse in Aetna coverage there, prompting Brandt to take the extraordinary step of traveling across the country for treatment.<\/p>\n
“I’m going to Boston and hoping to get treatment there,” she said. “They will accept our insurance at Dana-Farber, but Community doesn’t.”<\/p>\n
Action News asked city leaders about Community’s track record.<\/p>\n
“We saw what happened with Aetna last month. A second impasse now. Does Community bear any responsibility in your mind?” we asked Karbassi.<\/p>\n
“That’s a fair question,” he said. “I’ll tell you one thing. Community has been very transparent in answering any of our questions.”<\/p>\n
“They’re on notice as much as Blue Shield, but they’re the ones right now willing to negotiate… to the point where they’re willing to negotiate directly with our trust,” Karbassi said.<\/p>\n
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