FRESNO, CA — Fresno Unified school leaders will vote Thursday, Jan. 15, on a plan to expand health insurance choices for retirees. The move follows a contract dispute between Aetna and Community Medical Centers (CMC) that cut off access to local hospitals and doctors at the start of the year.
The dispute arose after Aetna and the medical network failed to reach a new agreement by a Dec. 31 deadline. As a result, starting Jan. 1, retirees could no longer visit CMC hospitals or clinics at the lower "in-network" prices.
On Jan. 12, the district announced it is working with the Fresno Teachers Association (FTA) and the Joint Health Management Board to expand insurance options. This board manages the district’s health benefits. The proposed plan would allow retirees to return to their previous "PPO" insurance plans, which generally give patients more freedom to choose their own doctors and hospitals.
Impact on Patients
The loss of coverage has had an immediate impact on local families. Emily Brandt is a retired teacher being treated for a rare blood cancer called lymphoma. She told YourCentralValley.com that the dispute has already led to denied medications and interrupted medical care.
In response to the situation, FTA President Manuel Bonilla called on Community Regional Medical Center to continue treating retirees and billing Aetna while the dispute remains unresolved.
CMC officials said that patients already in active treatment can ask Aetna for "continuity of care." This is a special permission that allows patients to keep seeing their current doctors for a limited time, often up to one year.
Background on the Dispute
District leaders said they renewed the contract with Aetna this past December, believing the insurance company and local hospitals were close to an agreement.
In July 2023, the school district moved retirees from government-run Medicare to a private "Medicare Advantage" plan. The move was intended to lower healthcare costs for both the district and the retirees.
While the vote on Thursday aims to provide help quickly, officials said it will likely take six months to a year to fully move retirees back to their previous insurance options.
