FRESNO, Calif. (KFSN) — With uncertainty surrounding the insurance coverage for thousands of Fresno Unified retirees, former employees are seeking answers from district leaders.
“I feel bad for some of these retirees 80, 90, like my neighbor, who went to the doctor and they told her, “you can’t come here,”” said former Fresno Unified teacher, Nancy Lind.
She is just one of over 6,000 retirees dealing with cancelled appointments and essential services denied since the start of the new year.
Amid uncertainty about insurance coverage for thousands of Fresno Unified retirees, former employees are seeking answers from district leaders.
The struggles come as a result of stalled negotiations between Community Medical Centers and insurance company Aetna, leaving retirees without in-network access to the Community Health System.
Educational leaders pointed to the providers on Monday.
“Folks need to realize that it is Community that can do this right now, by just accepting people and billing Aetna, they are choosing not to do this,” said Fresno Teachers Association President Manuel Bonilla.
Instead, Community Medical has suggested that those affected apply for a “continuity of care” provision.
Explaining in a statement:
“Upon Aetna’s approval, this would allow Community providers to continue services for up to a year for that patient.”
But Fresno Unified says the provision is not a cure-all.
“Its only for a few people under active treatment, so obviously our benefits department stands ready and has been reaching out to retirees that have those concerns,” said Chief Financial Officer Patrick Jensen.
Many retirees have also been told by Community to look for alternative providers, but that solution comes with out-of-pocket costs most can’t afford.
“That unfortunately has been the alternative, and why we are pressing so hard today on either having Community extend the contract and/or bill Aetna,” Jensen Explained
Bonilla doubled down on Community’s lack of action, saying, “To be absolutely clear, Community Regional Medical has an option, and has always had an option, to continue to provide services to our retirees during this negotiation process.”
The full statement from Community Medical Division President of Insurance Services & Managed Care Aldo De La Torre reads as follows,
“Community Health System shares the concern and frustration Fresno Unified educators, retirees, and their families are experiencing at the threat of losing in-network access to our hospitals and providers.
We are actively negotiating with Aetna and are committed to reaching an agreement that allows us to continue providing high-quality care at a fair rate. Our ability to provide high-quality, accessible care to the entire community depends on contracts that fairly reimburse physicians, nurses, and care teams for the services they deliver. To date, Aetna has not offered terms that meet that standard. We remain ready and eager to reach an agreement that preserves access for all Aetna members in our region, including Fresno educators and allied professionals.
If patients are in active treatment with a Community Health Partners physician, they can request authorization from Aetna for a ‘continuity of care’ provision. Upon Aetna’s approval, this would allow Community providers to continue services for up to a year for that patient.”
Superintendent Misty Her has announced that the Joint Health Management Board will meet on Thursday, January 15, to discuss alternatives that provide the retirees with the proper care.
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