{"id":124490,"date":"2026-01-08T01:28:09","date_gmt":"2026-01-08T01:28:09","guid":{"rendered":"https:\/\/www.newsbeep.com\/us-ca\/124490\/"},"modified":"2026-01-08T01:28:09","modified_gmt":"2026-01-08T01:28:09","slug":"thousands-of-fresno-unified-retirees-cut-off-from-health-care","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/us-ca\/124490\/","title":{"rendered":"Thousands of Fresno Unified Retirees Cut Off From Health Care"},"content":{"rendered":"

A dispute between Community Health System and Fresno Unified\u2019s health insurance provider, Aetna, has caused thousands of district retirees to be cut off from care.<\/p>\n

\u201cHere I am about 2 1\/2 years later and instead of lying in a bed paralyzed\u00a0on my left side and unable to communicate, I\u2019m healthy, active,\u201d a retiree, who previously had a stroke, told GV Wire. \u201cStrokes happen most often\u00a0to the elderly, which most retirees are. I was 72. To deprive us of access to this level of care would be terrible.\u201d<\/p>\n

Aetna and Community, the region\u2019s largest healthcare provider, failed to reach an agreement, ending the contract between them on New Year\u2019s Day. Immediately, Aetna\u2019s Medicare Advantage Plan removed Community from their network of care.<\/p>\n

And it is unclear if negotiations are continuing.<\/p>\n

\u201cUnfortunately, (Community) offered no extension of the current agreement to enable the parties to continue discussions to avoid member impact. Aetna is open to continuing negotiations if they wish to reconsider,\u201d Aetna Senior Manager of Corporate Communications Shelly Bendit said.<\/p>\n

About 6,500 retirees and dependents are enrolled in the program, and 1,500 received primary care services at Community, according to the district.<\/p>\n

\u201cWe understand that uncertainty about healthcare access is concerning, particularly for our retirees with ongoing medical needs,\u201d Fresno Unified Superintendent Misty Her said in a statement.<\/p>\n

Currently, Fresno Unified is working alongside partners to evaluate all options and assess potential paths forward, she said.<\/p>\n

Sharon Hart, a former Fresno Unified employee, whose husband is battling cancer, expressed frustration for what she considered a passive district response.<\/p>\n

\u201cWhen kids don\u2019t come to school, (the district) calls them. Administrators make home visits,\u201d Hart said. \u201cThat\u2019s how the district gets money\u2026 We\u2019re the opposite. We take money. We already sacrificed, now we\u2019re just a drain. No one\u2019s calling us.\u201d<\/p>\n

Community Medical Center Hub of Care<\/p>\n

Community Health includes four hospitals, which provide most of Fresno County\u2019s hospital care. Additionally, the health care provider employees a vast number of specialists in the area.<\/p>\n

Now, at least 1,500 retirees are losing easy access to this care.<\/p>\n

Aldo De La Torre, Community\u2019s division president of insurance services and managed care,\u00a0 explained retirees can request authorization from Aetna for a \u201ccontinuity of care.\u201d<\/p>\n

\u201cThis would allow Community providers to continue to provide services for up to one year upon Aetna\u2019s approval,\u201d said De La Torre.<\/p>\n

This is a convoluted process that requires energy and proper awareness, according to Hart. She has taken over this burden for her husband but emphasized that not everyone has a support system.<\/p>\n

\u201cHonestly, he told me yesterday when we were talking about this that he would just die (without her help),\u201d Hart said.<\/p>\n

Fresno Teachers Association President Manuel Bonilla says there is a way to rid retirees of this paperwork burden.<\/p>\n

\u201cCommunity just could simply see folks and bill out of network without having our folks to fill out additional paperwork,\u201d Bonilla told GV Wire. \u201cWhat we\u2019re calling on is for (Community) to allow our retired teachers to continue to see their providers while there\u2019s an ongoing negotiation.\u201d<\/p>\n

Out-of-network care raises costs that often must be paid out-of-pocket \u2014 a problem people are running into, Bonilla said.<\/p>\n

Expired agreements and failed negotiations are not new nor a localized issue. Community did not accept Anthem Blue Cross insurance for six months in 2023 as negotiations raged on between the two. Additionally, Aetna\u2019s contract with UConn Health in Connecticut recently expired<\/a>.<\/p>\n

Retirees Unhappy with Aetna<\/p>\n

Even before this dispute, many retirees have been unhappy with the level of coverage provided through Aetna, a private profit-driven company, since its implementation in 2023.<\/p>\n

The Fresno Unified Retirees\u2019 Association sent a letter of demand, threatening litigation, due to lack of access and higher costs through Aetna.<\/p>\n

\u201cFURA has learned that the district has disregarded its promise and has been imposing various changes on retirees\u2019 expected health benefits. In particular, more expensive health benefit charges have been made requirements for many retirees,\u201d the letter states. \u201cRetirees have also experienced a lack of medical services coverage through the new Aetna Plan, imposed upon them by the District.\u201d<\/p>\n

At the Dec. 17 School Board meeting, trustees unanimously agreed to renew the district\u2019s contract with Aetna despite sharing concerns of their own.<\/p>\n

\u201cAt this particular point in time, we\u2019re between a rock and a hard place,\u201d Trustee Elizabeth Jonasson-Rosas said at the dais. \u201cRegardless of the Community situation, (there is) dissatisfaction amongst our retirees with the current level of service.\u201d<\/p>\n

The district can end its agreement with Aetna if it is unable to maintain a service with a major hospital chain, such as Community, Fresno Unified CFO Patrick Jensen told the School Board. However, the change would be a long and laborious process, he said.<\/p>\n

\u201cI would like to challenge the notion that it would take six months. It did not take six months to move 6000 retirees (onto Aetna),\u201d said Elisabeth Robeldo, a current Fresno Unified teacher who works with FURA. \u201cThat was done at a breakneck pace. In fact, it happened so quickly that it was a bit of a surprise.\u201d<\/p>\n

The district said terminating the contract would be a last resort.<\/p>\n

History of Healthcare in Fresno Unified<\/p>\n

Decades ago, Fresno Unified agreed to provide lifetime healthcare benefits to employees, who in turn forewent salary increases.<\/p>\n

But retirees believe the district is failing to properly uphold their end of the bargain.<\/p>\n

Hart said she feels \u201cabsolutely screwed over, absolutely screwed over. There is no other way to say it.\u201d<\/p>\n

Retirees who qualify for Medicare, ages 65+, were shuffled into an Aetna Medicare Advantage Plan.<\/p>\n

Prior to the advantage plan, retirees had Medicare as a primary insurance and the district provided supplemental plan. Meaning, the district paid uncovered medical expenses from its own health fund, with a third-party handling paperwork.<\/p>\n

Now, Aetna Medicare Advantage is the only option of retirees ages 65+.<\/p>\n

The plan was negotiated by the Joint Health Management Board<\/a> \u2014 comprised of union representatives and district staff \u2014 and approved by the School Board. There is no retiree representative on JHMB.<\/p>\n

During that time, Fresno Unified paid $450 per member per month and Aetna Medicare Advantage submitted a bid of $298 per member per month, according to documents obtained by GV Wire. At the time, this created an annual net saving of $12.7 million.<\/p>\n

\"\"Top three medical insurance bids presented to the Joint Medical Health Board, 2022. (JHMB)<\/p>\n

Yet, the district will pay about $531 per member per month in 2026 \u2014 a 78% increase from 2023. Meanwhile, Medicare\u2019s self-reported costs increased 24-25% in the same period, placing it on track to exceed traditional costs.<\/p>\n

GV Wire reached out to multiple members of the JHMB board but received no response.<\/p>\n

Bonilla declined to comment on JHMB, saying it isn\u2019t related to or involved in negotiations between Aetna and Community.<\/p>\n

However, Fresno Unified Trustee Susan Wittrup said, \u201cIt\u2019s all connected.\u201d<\/p>\n

The next JHMB meeting is on Thursday, Jan. 15.<\/p>\n

Medicare Advantage Causes High Costs and Less Care<\/p>\n

Medicare eligible retirees have been unhappy with the restrictive advantage plan that pushes prior authorization for procedures, referral rules, denials, and insurer-run appeal \u2014 causing undue stress and longer wait times.<\/p>\n

The extra paperwork and delays, sometimes for life-saving treatment, more costs for medical providers and retirees who are on fixed incomes.<\/p>\n

\u201cFrom Community\u2019s perspective, what they\u2019ve told me is that costs them a lot of money. That\u2019s very expensive when they have to use doctors\u2019 time and nurses\u2019 time to appeal these denials,\u201d Hart said.<\/p>\n

Additionally, there was a lack of communication about the change, according to Hart and Robeldo.<\/p>\n

\u201cFolks were not informed and feel as though these things happened in private and in secret and with a lack of transparency,\u201d Robeldo said.<\/p>\n

The district told the Board that the health services would remain the same under Aetna when they voted to approve the contract, Wittrup said. However, it has been producing complications since.<\/p>\n

\u201cThere have been rumblings of problems ever since that Medicare Advantage Plan came in. Lots of people are saying that if they just had Medicare, they would do much better on coverage,\u201d she said.<\/p>\n

Related Story: Fresno Unified\u2019s Health Insurer Creating Headaches for Some Retirees<\/a><\/p>\n

Bottom line: a large portion of retirees are seeking the choice to return to traditional Medicare.<\/p>\n

\u201cThe main thing now is to have the option to return to their traditional Medicare program with their employer subsidized supplemental program. Those who want to stay on Medicare Advantage, who enjoy the care and are happy with the service (can stay). We do not wish to separate folks from their preferences, just as we would appreciate the same. So that is the idea of choice,\u201d Robeldo said.<\/p>\n","protected":false},"excerpt":{"rendered":"A dispute between Community Health System and Fresno Unified\u2019s health insurance provider, Aetna, has caused thousands of district…\n","protected":false},"author":2,"featured_media":124491,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[31],"tags":[93,112,114,113],"class_list":{"0":"post-124490","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-fresno","8":"tag-featured","9":"tag-fresno","10":"tag-fresno-headlines","11":"tag-fresno-news"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts\/124490","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/comments?post=124490"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/posts\/124490\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/media\/124491"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/media?parent=124490"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/categories?post=124490"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ca\/wp-json\/wp\/v2\/tags?post=124490"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}