Blue Shield of California and Community Medical Centers Negotiations: What You Need to Know
Blue Shield of California has been engaged in extensive negotiations with Community Medical Centers (CMC) for several months, aiming to reach a new agreement that ensures fair payment while prioritizing member access to quality healthcare. Despite this effort, CMC’s refusal to tie any rate increases to performance metrics poses a significant challenge to progress.
Impending Changes for Blue Shield Members
Starting February 1, 2026, CMC facilities will no longer be part of Blue Shield’s in-network options. This change may lead to concerns among members, but Blue Shield is committed to minimizing disruption. The organization has a robust provider network in Fresno County, with alternative in-network options available, such as St. Agnes Medical Center and Valley Children’s Hospital.
Ensuring Continuity of Care
During this transition, Blue Shield is focused on ensuring that members can maintain their healthcare services without interruption. Families have expressed frustration over rising healthcare costs and are looking for effective solutions. Blue Shield is dedicated to collaborating with CMC to reach a resolution that balances the need for affordable healthcare with the delivery of high-quality services throughout San Joaquin Valley and California.
Frequently Asked Questions (FAQs)
What should I do if I’m currently receiving care at Community Medical Centers?
If you receive care from CMC, be aware that those facilities will be out-of-network starting February 1, 2026. It’s advisable to speak with your healthcare provider to arrange a referral to an alternative in-network facility. Blue Shield’s Continuity of Care program also assists eligible members during this transition, allowing them to continue seeing their current provider. Members can begin the application process 30 days prior to the network termination date.
Which facilities will no longer be part of Blue Shield’s network?
The following facilities will be out-of-network for Blue Shield members:
- Clovis Community Hospital
- Community Regional Medical Center
- Fresno Heart and Surgical Hospital
What alternative hospitals can Blue Shield members seek care from at in-network prices?
In-network options include:
- St. Agnes Medical Center
- Valley Children’s Hospital
Are the same medical services available at alternative in-network hospitals?
Yes, most services provided by Community Medical Centers are also available through the alternative hospitals. However, certain medically necessary services—such as acute psychiatric care and burn services—will continue to be offered at Community Regional Medical Center at in-network rates.
Will emergency services from Community Medical Centers still be available?
Yes, if members require emergency services, they should call 911 or visit the nearest emergency room. Blue Shield offers comprehensive emergency care benefits at Community Medical Centers.
Resources for Members
For more information regarding alternative provider networks and frequently asked questions, please visit the Provider Networks page. For details on how Blue Shield is working to keep healthcare affordable, check out the Healthcare Affordability page.
Members are encouraged to stay informed and take proactive steps to ensure their healthcare needs are met during this upcoming change.
