Fresno Unified and the Fresno Teachers Association joined forces Monday to demand Community Medical Centers provide health care to district retirees who were recently cut off from care.

On Jan. 5, the district announced contract disagreements between Community and Fresno Unified’s health insurance provider, Aetna, disrupted health care coverage for hundreds of retirees.

At a joint news conference at the district’s downtown Fresno office Monday, Fresno Unified officials along with the Fresno Teachers Association called on Community Medical Centers to resume treatment of retirees before a crowd of reporters and former employees, some of whom expressed to GV Wire frustrations about their health care.

“(Retirees) have shared countless alarming accounts of doctors abruptly discontinuing their care, delays or denials in accessing medications, and being turned away from essential services,” Fresno Unified Superintendent Misty Her said.

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

On Jan. 1, Aetna’s Medicare Advantage Plan removed Community from their network of care after the two failed to reach a contract agreement. The two organizations are continuing negotiations.

“Our message to Community is clear. Restore retiree health care access now,” Fresno Teacher Association President Manuel Bonilla said at the conference. “If you refuse, you will only further expose that our retirees are being used as bargaining chips in a contract dispute.”

In the meantime, Fresno Unified and union leaders said Community needs to take action to support retirees. Her said Community could give an extension of care during the negotiation period or accept Medicare reimbursement rates.

Community’s division president of insurance services and managed care, Aldo De La Torre, said the hospital needs a contract that adequately reimburses hospitals for their care. De La Torre said they “share the concerns and frustrations with Fresno Unified retirees.”

“(We) are committed to reaching an agreement that allows us to continue providing high-quality care at a fair rate,” De La Torre said in a statement to GV Wire. “Our ability to provide high-quality, accessible care to the entire community depends on contracts that fairly reimburse physicians, nurses, and care teams for the services they deliver. To date, Aetna has not offered terms that meet that standard.”

Community recently contacted the district to set up a meeting, according to Fresno Unified Trustee Susan Wittrup.

Retirees Lose Community as In-Network Provider

The dispute caused hundreds of Fresno Unified retirees to lose easy access to the region’s largest healthcare provider.

About 6,500 retirees and dependents are enrolled in the program, and 1,500 received primary care services at Community, according to the district.

Community has prompted retirees to request authorization from Aetna through a “continuity of care.”

“This would allow Community providers to continue to provide services for up to one year upon Aetna’s approval,” De La Torre said. In the meantime, the health system will continue to provide emergency care to everyone affected.

But “continuation of care” only covers a narrow scope of healthcare and patients, according to Fresno Unified CFO Patrick Jensen.

“That term does a lot of heavy lifting, when in reality, the legal requirements for that is it only covers a very small segment of the population,” he said. “So I just want to be very clear to say that the continuation of the care provision is not a solution for the vast majority of our members.”

The district is willing to escalate the issue if Community does not act.

“I think if this isn’t resolved, those reports and those formal grievances are going to be looked at, if this needs to escalate into some call to the attorney general or some lawsuit or demand that comes next, I don’t know. I’m hoping we don’t go there,” School Board President Veva Islas said. “I’m hoping that our call to action is respected and that in short order things do change.”

Some Retirees Seek Traditional Medicare

A group of retirees are advocating for a return to traditional Medicare, saying Aetna’s Medicare Advantage Plan has failed them.

About 15 retirees attended the press conference, with one demanding answers during a tense moment with Bonilla.

“Some of our folks don’t like Medicare Advantage, and we’re hearing that,” said Jon Bath, a member of the Joint Health Management Board. “So (JHMB is) going to move on that. We’re going to be decisive. We’re going to do it Thursday and we’ll move fast as we can through the regulatory procedures.”

JHMB — comprised of union representatives and district staff — is responsible for negotiating district staff and retiree healthcare plans.

However, a similar situation to what is occurring now could affect those on traditional Medicare, Jon Bath.

But the complaints of people demanding traditional Medicare don’t stem from the current issue.

“I’ve heard from people that have been on the Medicare Advantage plan when negotiations were not happening, when everything was supposed to be normal. They’re getting denied right and left on medicine and procedures,” Wittrup said. “And they’re just really giving them the runaround.”