Community Medical Centers and Fresno Unified\u2019s insurance provider, Aetna, reached a contract agreement Tuesday, restoring access to care for thousands of district retirees.<\/p>\n
\u201cEffective\u00a0immediately, Community will rejoin\u00a0Aetna\u2019s Medicare PPO health\u00a0plan\u00a0network of participating care providers, providing\u00a0those\u00a0members with in-network access to Community hospitals\u00a0and facilities\u00a0and affiliated physician groups,\u201d a spokesperson for Community said in a statement.<\/p>\n
The contract between Aetna and Community, the region\u2019s largest healthcare provider, ended Jan. 1 after the two parties failed to come to a consensus. Immediately, Aetna\u2019s Medicare Advantage Plan removed Community hospitals and health partners from their network of care.<\/p>\n
Related Story: Thousands of Fresno Unified Retirees Cut Off From Health Care<\/a><\/p>\n This effectively cut off care for 6,500 retirees and dependents enrolled in the Medicare Advantage program, including the approximately 1,500 receiving primary care through Community.<\/p>\n But efforts by the district and labor unions led to restoration of some care, including clinic visits and prescription refills. Now, all services will be available to retirees.<\/p>\n \u201cThis agreement will ensure Fresno Unified School District retirees have continued access to Community\u2019s facilities and affiliated providers,\u201d said Aldo De La Torre, Community\u2019s division president of insurance services and managed care.<\/p>\n The contract is retroactively effective Jan. 1, according to the statement.<\/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 Fresno Unified did not respond to GV Wire\u2019s request for comment in time for publication.<\/p>\n Care Loss Creates Discord in Fresno Unified<\/p>\n Some district retirees have been advocating for a return to traditional Medicare, saying Aetna\u2019s advantage was restrictive and did not qualify as \u201clifetime benefits.\u201d These concerns came to a head in January.<\/p>\n Due to increased demands, the Joint Health Management Board \u2014 comprised of union leadership and district administration \u2014 voted to restore traditional Medicare with a district-supplied secondary plan.<\/p>\n But the new coverage will take effect on Jan. 1, 2027 \u2014 almost one year from now.<\/p>\n