Fresno Unified School District responded to a complaint letter alleging elder abuse and opposing Aetna Medicare Advantage, calling claims “baseless” and “misleading.”

On Jan. 22, a demand letter was filed on behalf of 6,200 retirees enrolled in Aetna Medicare Advantage, saying the health insurance “doesn’t constitute the lifetime medical coverage” promised to retirees.

In a statement issued Monday, the district pushed back against that claim.

“Everything that was promised to retirees in recognition of their years of service remains intact and continues to be honored today,” Fresno Unified stated. “The issue currently affecting some retirees is not a loss of benefits or a contract violation. It is a provider network dispute.”

Aetna-Community Medical Dispute

A negotiation dispute between Aetna and Community Medical, the region’s largest healthcare provider, caused thousands to be cut off from care — amplifying retiree concerns.

The network dispute does not equate loss of coverage or guaranteed benefits, the direct said.

However, the letter points to “network instability” and “restricted provider networks” as the origin of these issues.

Prior to the advantage plan, retirees had Medicare as primary insurance and a district provided secondary plan. On Jan. 16, the district’s Joint Health Management Board voted to allow that option to return.

But retirees are requesting an expedited timeline on the plan, which will not go into effect until Jan. 1, 2027.

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.

The district’s statement did not comment on the letter’s timeline.

Related Story: Fresno Unified Retirees Allege Elder Abuse Via Health Care Change

Some Retirees Created More Worry With Disinformation: District

Fresno Unified says that retiree concerns have escalated due to the spread of inaccurate information, including some advising retirees to disenroll from their coverage.

Network disputes are “not uncommon in today’s health care system and is being actively addressed,” the district said. Fresno Unified has been working with Community, which agreed to allow care through Feb. 20.

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’s contract with UConn Health in Connecticut recently expired.

The letter of demand asserts that the district should have taken these disputes into consideration.

“The district’s conduct — knowing or reasonably should have known that network disruptions, prior authorization denials, and plan opacity would disproportionately harm the oldest, most vulnerable retirees—constitutes systematic elder abuse,” the letter states.

Currently, Aetna’s Medicare Advantage PPO and Kaiser Senior Advantage HMO are the only options for retirees ages 65+.

But disenrolling is not the answer, according to Fresno Unified and the Fresno Teachers Association.

And the district warns that “opting 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.”

Related Story: Thousands of Fresno Unified Retirees Cut Off From Health Care

Fresno Unified ‘Included Retiree Representatives in Coverage Change

Retirees were shuffled onto the Aetna Medicare Advantage Plan in 2023, without retiree consent, consultation, or legal justification, according to the complaint letter.

“A structure intended to ‘embody core union values: transparency, democratic representation, informed consent, and accountability to the members whose lives are affected’ instead evolved into a decision-making apparatus that made changes of extraordinary permanence with minimal engagement of members or retirees,” it states.

But the district says that is not the case. The Joint Health Management Board — comprised of union representatives and district leaders — met with a health care consultant representing retirees. They met four times over an eighteen-month period from 2021 to 2022.

Related Story: Fresno Unified Retirees Healthcare Demands Are Met — for Now

“(The plan) resulted from a transparent and deliberate process that included retiree representatives from the Fresno Unified Retiree Association,” the district states.

The plan took nine months to implement according to the district “underscoring the regulatory, operational, and logistical complexity involve,” the statement said.

Retirees did not receive communications until spring 2023, multiple retirees previously told GV Wire.

Now, the district is assuring retirees that their health care coverage is not at risk.

“The District remains committed to providing retiree benefits and working with all parties to ensure continuity of care,” the response states.