Children's Hospital cuts ties with Sante Community Physicians

FRESNO, Calif. (KFSN) -- Action News has learned Children's Hospital Central California has cut ties with a local physicians group, forcing thousands of families into costly out-of-network health care plans.

Children's Hospital sent a letter home to parents this week, warning of the impending switch in coverage.

Right now the hospital and that physician's group, Sante Community Physicians both say children will still be seen by specialists regardless of the changes.

The big questions looming are how quickly they can get in and how much it will cost.

Melissa Rodriguez spends a lot of time playing with her three boys. The two oldest, a 7 and 2-year-old also spend a lot of time seeing a long list of specialists at CHCC.

"It's seeing endocrinologist, geneticists, cardiologist, immunologist; all of those are different authorizations. All of those take time to process," she said.

Rodriguez called Action News after receiving a frustrating letter in the mail. In the letter the hospital says it cut ties with Sante Community Physicians.

Sante represents about a thousand independent doctors around the Valley; many of them are specialists at Children's Hospital.

Those doctors, as of October 15th will no longer be considered in-network at CHCC. Instead they will be out-of-network under Sante's HMO plans. That means some patients, roughly three percent of all visits last year according to the hospital, face a potential of costlier doctor visits.

"We did not want this to happen. Sante put us in this position," said hospital representative Zara Arboleda. "We are now asking all of our patients to contact Sante and their HMO's directly to figure out how we can still care for them."

Both Sante and Children's Hospital say despite the cancelled contract kids with critical medical needs will still see their doctors.

And Sante says it will authorize patients listed as out-of-network to be treated. "Our priority at Sante is that the children get taken care of, and that no additional burden financially falls on the parents," said Dr. Daniel Bluestone, Sante's Chief Medical Officer.

This change only impacts Sante HMO plans, mostly issued through Fresno employers.

The two groups have been partnered for about 16 years. Children's Hospital says it's trying to keep costs low. And it blames Sante for trying to create its own network of physicians to compete with it, but Sante says that's a flat out lie.

Either way, parents like Rodriguez feel trapped in the middle. "Our children are sitting in limbo, with services that they need to get done," She said. "And us, as parents, need to take the risk of either it will or won't be paid."

Rodriguez says she's preparing to do a lot more legwork making sure those approvals for coverage are properly processed.

Emergency room visits for Sante patients will still be treated as in-network.