Fresno Unified School District responded to a complaint letter alleging elder abuse and opposing Aetna Medicare Advantage, calling claims \u201cbaseless\u201d and \u201cmisleading.\u201d<\/p>\n
\u201cThe issue currently affecting some retirees is not a loss of benefits or a contract violation. It is a provider network dispute.\u201d \u2014 Fresno Unified statement<\/p>\n
On Jan. 22, a demand letter was filed on behalf of 6,200 retirees enrolled in Aetna Medicare Advantage, saying the health insurance \u201cdoesn\u2019t constitute the lifetime medical coverage\u201d promised to retirees.<\/p>\n
In a statement issued Monday, the district pushed back against that claim.<\/p>\n
\u201cEverything that was promised to retirees in recognition of their years of service remains intact and continues to be honored today,\u201d Fresno Unified stated. \u201cThe issue currently affecting some retirees is not a loss of benefits or a contract violation. It is a provider network dispute.\u201d<\/p>\n
Aetna-Community Medical Dispute<\/p>\n
A negotiation dispute between Aetna and Community Medical, the region\u2019s largest healthcare provider, caused thousands to be cut off from care \u2014 amplifying retiree concerns.<\/p>\n
The network dispute does not equate loss of coverage or guaranteed benefits, the direct said.<\/p>\n
However, the letter points to \u201cnetwork instability\u201d and \u201crestricted provider networks\u201d as the origin of these issues.<\/p>\n
Prior to the advantage plan, retirees had Medicare as primary insurance and a district provided secondary plan. On Jan. 16, the district\u2019s Joint Health Management Board voted to allow that option to return.<\/p>\n
But retirees are requesting an expedited timeline on the plan, which will not go into effect until Jan. 1, 2027.<\/p>\n
The retiree letter says the district must confirm acceptance of the demands and a timeline for restoration of coverage by Feb. 28 to avoid litigation.<\/p>\n
The district\u2019s statement did not comment on the letter\u2019s timeline.<\/p>\n
Related Story: Fresno Unified Retirees Allege Elder Abuse Via Health Care Change<\/a><\/p>\n Some Retirees Created More Worry With Disinformation: District<\/p>\n Fresno Unified says that retiree concerns have escalated due to the spread of inaccurate information, including some advising retirees to disenroll from their coverage.<\/p>\n Network disputes are \u201cnot uncommon in today\u2019s health care system and is being actively addressed,\u201d the district said. Fresno Unified has been working with Community, which agreed to allow care through Feb. 20.<\/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\u00a0recently expired<\/a>.<\/p>\n The letter of demand asserts that the district should have taken these disputes into consideration.<\/p>\n \u201cThe district\u2019s conduct \u2014 knowing or reasonably should have known that network disruptions, prior authorization denials, and plan opacity would disproportionately harm the oldest, most vulnerable retirees\u2014constitutes systematic elder abuse,\u201d the letter states.<\/p>\n Currently, Aetna\u2019s Medicare Advantage PPO and Kaiser Senior Advantage HMO are the only options for retirees ages 65+.<\/p>\n But disenrolling is not the answer, according to Fresno Unified and the Fresno Teachers Association.<\/p>\n And the district warns that \u201copting out (of coverage) at this time would place a retiree in individual traditional Medicare rather than District-sponsored group coverage, and traditional Medicare alone does not include prescription drug or supplemental coverage unless purchased separately.\u201d<\/p>\n