Health care fully restored for Fresno Unified retirees, Community Health System says
Fresno Unified retirees can again receive in-network coverage through Community Health System after the region’s largest hospital system resolved its network dispute with Aetna.
“Effective immediately, Community will rejoin Aetna’s Medicare PPO health plan network of participating care providers, providing those members with in-network access to Community hospitals and facilities and affiliated physician groups,” a Community Health System spokesperson said Tuesday evening in a statement to The Bee.
About 6,200 Fresno Unified retirees and their dependents abruptly lost health care access on New Year’s Day after Community Health System and Aetna, the district’s private PPO insurer, failed to reach terms on a contract.
Community Health System’s contract with Aetna is retroactively effective Jan. 1, according to the statement.
“This agreement will ensure Fresno Unified School District retirees have continued access to Community’s facilities and affiliated providers,” said Aldo De La Torre, division president for Community Health System.
On Dec. 17, Fresno Unified’s governing board approved the continuation of the Aetna Medicare Advantage Plan for 2026, even as CHS and Aetna had not yet agreed to a new contract before a Dec. 31 deadline. The program carries an annual cost of $40 million for 2026 for Fresno Unified, and a 12% cost increase for 2027.
Board trustees voted to renew the district’s retiree insurance through Aetna under the impression that the contract negotiations would be resolved promptly, Superintendent Misty Her said.
Mediation efforts by the district and its labor unions over the past month led to the restoration of partial services in mid-January. The insurance disruption fueled discontentment over insurance benefits among some retired employees that had been simmering for years.
Some Fresno Unified retirees said their benefits have felt noticeably diluted after the school district replaced its preferred provider organization, or PPO, insurance plan in 2023 with for-profit Aetna’s Medicare Advantage Plan. While the district has said Aetna Medicare Advantage Plan offers more benefits at lower premiums, retirees said the change has led to a more restricted provider network, increased red tape, and higher referral and denial rates.
Amid stalled negotiations between CHS and Aetna, the district’s health insurance board decided Jan. 15 to add a health care option for retirees similar to what was offered prior to 2023. The additional option will not be implemented until 2027, due to regulatory requirements.
In a complaint letter sent to the district on Jan. 23, retirees urged the district to immediately cease the for-profit Aetna Medicare Advantage Plan and switch back to the insurance plan provided before 2023. The district-paid lifetime benefits were written in the employees’ bargaining agreements, according to the retirees.
Fresno Unified officials called the complaint letter baseless and misleading, insisting that there was no loss of benefits during the insurance change in 2023 and the only cause for the disruption was the provider network dispute.
Despite the resolution of the network dispute, some retirees said they still want to hold Fresno Unified accountable for the 2023 insurance change.
“This does not change our determination to take this case further to court if necessary,” said Emily Brandt, a retired English teacher at Bullard High School. “It is still an illegal move by active unions and management to change the lifetime health benefits of retirees in order to save money.”
