FRESNO, Calif. (KFSN) — Over 6,000 Fresno Unified retirees have gone without in-network healthcare coverage since the start of the year as negotiations stalled between Community Medical Centers and insurance company Aetna.<\/p>\n
Aetna releasing a statement saying in part, “We engaged with them in good faith and offered fair rate terms. Unfortunately, they did not grant any extension of the current agreement to enable the parties to continue discussions to avoid member impact.”<\/p>\n
That’s left FUSD retirees like Sharon Hart at a loss.<\/p>\n
“These are real people with real relationships with their doctors, and in some cases, life and death situations happening right before them,” Sharon Hart stated.<\/p>\n
But on Wednesday, Community and Fresno Unified announced a temporary solution.<\/p>\n
Community Health System releasing a statement that reads in part, “While we work to reach an agreement with Aetna, through mid-February, Community providers will accept FUSD retirees covered by Aetna for clinic visits and to obtain prescription refills.”<\/p>\n
The district’s statement says that agreement is through February 20th.<\/p>\n
Fresno Teachers Association President, Manuel Bonilla, says while this is a good step, it isn’t enough.<\/p>\n
“This is a piecemeal approach,” Bonilla said. “It’s not a systems approach, and it puts the burden back on the retiree, as opposed to what could be a very quick solution, and that is for a contract extension.”<\/p>\n
Neither statement defines what’s considered a clinic visit.<\/p>\n
“It creates more questions than it provides clarity, and our goal is to provide clarity,” Bonilla said.<\/p>\n
Sharon and her husband Dennis have already been searching for alternative doctors after being turned away from Community.<\/p>\n
“They said, ‘We are not even seen Aetna patients at all right now; we’ve been told about to see Aetna patients.’ He asked about out of pocket payments, and they didn’t even entertain the idea,” Sharon recalled.<\/p>\n
“The person over at Community wouldn’t even talk to me,” Dennis stated.<\/p>\n
Dennis has been seeing the same oncologist for eight years with appointments lined up in February before coverage was cut off.<\/p>\n
“Now you try to find somebody who’s never seen you, doesn’t know you, never talked to you, and all he is going to do is read the paper in front of him. Here’s what I’ve had, here’s what I’ve done. How does he catch up that quickly? That’s the frightening thing,” Dennis explained.<\/p>\n
Part of Community’s statement says it will honor certain continuity of care provisions and Aetna’s statement says members may be eligible for Transition of Care coverage.<\/p>\n
It’s not clear how quickly those claims could be approved.<\/p>\n
Full statement from Community Health System President & CEO Craig A. Wagoner:<\/p>\n
“We are working with Fresno Unified to help ensure FUSD retirees have access to our hospitals and providers during our negotiations with Aetna and minimize disruption in care.<\/p>\n
While we work to reach an agreement with Aetna, through mid-February, Community providers will accept FUSD retirees covered by Aetna for clinic visits and to obtain prescription refills.<\/p>\n
In addition:<\/p>\n
Community will certainly provide all emergency services regardless of insurance status.<\/p>\n
We will honor continuity of care provisions for those in active treatment, such as but not limited to, cancer care.<\/p>\n
For all other services, we will continue to request from Aetna approval to provide in-network services to FUSD retirees on a case-by-case basis.<\/p>\n
We are committed to doing everything we can to resolve the contract negotiation with Aetna in a timely manner that also allows us to continue providing high-quality care at a fair rate. However, Community Health System must demand reimbursement that covers the cost of the care we provide so that our region’s most essential healthcare provider-for more than 125 years-remains financially stable to continue serving the needs of our Valley.”<\/p>\n
Entire statement from Fresno Unified:<\/p>\n
“Following talks with Fresno Unified, Community Medical Centers has agreed to a temporary solution to the disruption of Aetna insurance coverage for retirees. The disruption resulted from a breakdown in negotiations between Community Medical Centers and Aetna. Community Medical Centers has agreed to an extension of retiree access to physician office visits and to obtain prescription refills, through Feb. 20.”<\/p>\n
Full statement from Aetna:<\/p>\n
“As of January 1, 2026, Community Medical Centers and Community Health Partners in Fresno are no longer in network for Aetna Medicare Advantage members but continue to participate in our Commercial plans. We engaged with them in good faith and offered fair rate terms. Unfortunately, they did not grant any extension of the current agreement to enable the parties to continue discussions to avoid member impact. As part of our provider network in the Fresno area, we have other providers available to care for our members. Members that were receiving treatment from Community Medical Centers and Community Health Partners may be eligible for Transition of Care coverage to have their care covered at the in-network benefit level for a designated period upon approval by Aetna.<\/p>\n
We are available to help members who have questions, and they can reach us by calling the number on their membership ID card.”<\/p>\n
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