Thousands of retired Fresno Unified employees abruptly lost access to health care services from Community Medical Centers on New Year’s Day, and it’s unclear when the situation will be resolved.
The disruption happened because one of Fresno Unified’s insurers, Aetna, was unable to reach an agreement with Community Medical Centers by the Dec. 31 deadline. As a result, Aetna removed Community Medical Centers and Community Health Partners from its provider network effective Jan. 1.
Approximately 6,200 retirees and dependents are enrolled in the Aetna program, and 1,500 of them received primary care services at Community Medical Centers at the time of the disruption, according to Fresno Unified.
“It’s really hard for them, because some of them are in their 80s, they’re elderly. What I’m hearing is they’re having a hard time getting things approved, getting coverage,” Trustee Susan Wittrup said at a December school board meeting. “I was in the district when we started the lifetime benefits, and I remember it well, because employees gave up compensation and increases in salary to have the lifetime benefits.”
Wittrup said about 200 retirees received letters notifying them that their medications would be discontinued, with no alternative listed.
At the Dec. 17 board meeting, the seven-member school board voted unanimously to continue the contract with Aetna, though they all agreed that it’s a disturbing situation.
“Even though that’s the case, this allows for continuity of service for our retirees. There are other medical providers, the 75% of our retirees who aren’t being impacted by the dispute with Community, this continues coverage for them,” said Patrick Jensen, the district’s chief financial officer. “For 25% of our retirees who are caught up in this and have a primary service provider within Community, this doesn’t solve the immediate need, but if they come to an agreement, then those employees won’t have any disruptive coverage.”
Jensen told the board that it will take six months to move all the retirees to a new health insurance plan, and it’s highly disruptive because everyone has different doctors, pharmacies, and medications that might not be covered by the new plan.
However, if Aetna eventually cannot reach an agreement with Community Medical Centers, that would be a qualifying factor for Fresno Unified to eliminate the contract with Aetna, Jensen said, due to its inability to maintain service with a major hospital chain in Fresno.
An update on Dec. 30 issued by Fresno Unified’s Joint Health Management Board reminded retirees that they can still receive services from Community Medical Centers as long as the provider is willing to bill Aetna as an out-of-network provider and the retiree is willing to pay a higher rate.
Her acknowledged it’s a scary time for many, not just members of Fresno Unified, but all organizations that use Aetna as an insurer. The JHMB and the district’s benefits team are actively evaluating all options and are committed to transparent communication as new, verified information becomes available, Her said in a statement.
The district also reminds retirees that they will still be seen if they have an emergency, as per a federal law, the Emergency Medical Treatment and Labor Act, which prevents Medicare-participating hospitals from refusing to provide emergency services.