TO: Fresno Unified School District Employee Health Care Plan Participants in PPO Plan Options A and B
DATE: July 22, 2021
As of midnight, July 15, 2021, Anthem Blue Cross and Dignity Health were not able to reach a new agreement before their contract expired. At this time, Dignity Health is no longer an in-network provider for Plan Options A and B under the District’s medical plans. Any services provided at Dignity Health on or after 5:00 PM PST on July 15, 2021, will be charged at the out-of-network rate (except for approved continuity of care services).
Please note that out-of-network rates will result in significant out-of-pocket costs that are not reimbursed by the District’s medical plan. If you or your dependent(s) have/had any services scheduled at Dignity Health on or after 5:00 PM PST on July 15, 2021, you may wish to consult with your medical provider to discuss potential alternatives.
Continuity of Care – Eligibility & Provisions
In-Patient Services: If a member was in-patient at 4:59 PM on July 15, 2021, then the member shall continue to receive uninterrupted care at Dignity Health until he or she is discharged. The member’s in-network benefit levels will apply for the entire in-patient stay.
Existing Courses of Treatment: In addition, if a member began a course of treatment at Dignity Health before 5:00 PM PST on July 15, 2021, the member (or his/her physician) can request continuity of care. Conditions that may be eligible for continuity of care include the following:
- Members in an active course of treatment for an acute medical or behavioral health condition
- Members in an active course of treatment for a serious chronic condition
- Members who are pregnant, regardless of trimester
- Members with a maternal mental health condition diagnosed by their treating health care provider
- Members with a terminal illness
- Members who are newborn children between the ages of birth and 36 months
- Members with a surgery or other procedure that was authorized by Anthem Blue Cross prior to the termination date and scheduled to occur within 180 days after the termination date.
Requesting Continuity of Care: If a member’s condition is consistent with one of those listed above, please contact Delta Health Systems at (800) 807-0820 to request the Continuity of Care/Transition of Care Request Form. The member and his/her physician will need to complete the form and return it to Anthem as specified on the form.
SPECIAL NOTE: Continuity of care services will be considered by the Anthem Blue Cross Transition Assistance Department on a case-by-case basis. If a case is approved, the claim will be processed at in-network benefit levels.
Be Sure to Ask First – “Are You Part of Dignity Health System?”
Below you will find a list of terminating Dignity Health hospitals and alternative hospitals in their surrounding area. While the list only highlights hospitals, there are many more facilities and providers affiliated with Dignity Health. Should you wish to seek the services of a new provider under the PPO plan, please be sure to ask if they are part of Dignity Health. If they are, their services will be billed at the non-PPO benefit level.
List of Terminating & Alternative Hospitals (PDF) – Updated 8/18/21
SPECIAL NOTE: Due to system complexities during this change, information available via the Anthem Blue Cross website may not be accurate regarding identifying Dignity Health providers. We strongly advise that you first follow up with your physician/provider or the Dignity Health website at www.dignityhealth.org to verify their affiliation.
Stay Tuned for More Information
The Joint Health Management Board strives to ensure its members are informed and responsible health care consumers. Though this situation remains out of our control, we will continue to do our best to keep you informed as it unfolds.
Should Anthem Blue Cross and Dignity Health reach an agreement in the coming days and weeks, we will provide a formal notice at that time. Until then, you may find the most up-to-date information at the JHMB’s website (www.JHMBHealthConnect.com).
We appreciate your patience and understanding. We will continue to manage and maintain the highest quality health and wellness benefits on behalf of the District’s employees, retirees, and their families.