TO: Fresno Unified School District Employee Health Care Plan Participants in PPO Plan Options A and B
DATE: June 1, 2018
As of midnight, June 1, 2018, Anthem Blue Cross and St. Agnes Medical Center were not able to reach a new agreement before their contract expired. At this time, St. Agnes Medical Center is no longer an in-network provider for Plan Options A and B under the District’s medical plans. Any services provided at St. Agnes Medical Center on or after June 1, 2018, 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 any services scheduled at St. Agnes Medical Center on or after June 1, 2018, 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 11:59 PM on May 31, 2018, then the member shall continue to receive uninterrupted care at St. Agnes Medical Center 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 St. Agnes Medical Center before June 1, 2018, 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 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.
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.
Alternate Providers Located Near St. Agnes Medical Center
To check the participating status of Anthem Blue Cross hospital and physician providers, please consult Anthem Blue Cross’ website at www.anthem.com/ca. The following is a partial list of alternate participating general acute care hospitals in the St. Agnes Medical Center service area:
- Clovis Community Hospital, 2755 Herndon Avenue, Clovis, CA 93611
- Community Medical Center Fresno, 2823 Fresno Street, Fresno, CA 93721
- Fresno Heart and Surgical Hospital, 15 E. Audubon Drive, Fresno, CA 93720
- Fresno Surgical Hospital, 6125 N. Fresno Street, Fresno, CA 93710
- Madera Community Hospital, 1250 E. Almond Avenue, Madera, CA 93637
NOTE: The alternate facilities may not be participating in all Anthem networks. Anthem members will be advised to verify with both their provider and the Anthem Blue Cross website at www.anthem.com/ca that the alternate facility is participating in their benefit plan’s network.
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 St. Agnes Medical Center 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.