What's at stake?
Fresno Unified leaders are calling for Community Health System to offer healthcare services to around 1,500 the district's retirees on Medicare amid unresolved negotiations between Community and Aetna, one of the district's insurance providers.
Fresno Unified School District leaders on Monday called on Community Health System to allow retired district employees access to its services, saying that Community has refused care to retirees amid unresolved negotiations.
Specifically, one of the district’s insurance providers, Aetna, was not able to resolve negotiations with Community on their own by a Dec. 31 deadline. That day, Community’s facilities were rendered out-of-network for about 1,500 FUSD retirees on Medicare who received care primarily at Community.
Superintendent Misty Her was joined by Fresno Teachers Association President Manuel Bonilla, the FUSD Board of Education and the Joint Health Management Board (JHMB) during Monday’s news conference.
“Over the past two weeks, my office, our district team and our trustees, have been inundated with messages from retirees,” Her said. “They have shared countless alarming accounts of doctors abruptly discontinuing their care, delays or denials in accessing medications and being turned away from essential services.”
Her said that the JHMB executive committee has been communicating almost daily about this matter since Jan. 1.
“Last Friday, Fresno Teachers Association and the Joint Health Management Board met with us in identifying a solution in light of Community Medical Center’s failure to do so, and I am grateful for their willingness to collaborate,” Her said.
According to Her, the JHMB will meet on Thursday to vote on alternative options to provide care to retirees. District leaders did not share any details about what alternatives are under consideration.
Bonilla, the teachers union president, said that the contract dispute has been transformed into a healthcare crisis by Community, saying refusal to return healthcare access to retirees would “only further expose that our retirees are being used as bargaining chips in a contract dispute.”
Additionally, Bonilla noted that despite the unresolved negotiations, Community can still provide care to the retirees and receive reimbursement for doing so, but has chosen to do otherwise.
“Again, to be absolutely clear, Community Regional Medical has an option, and always has had an option, to continue to provide services to our retirees during this negotiation process and simply bill the insurer carrier for reimbursement,” Bonilla said. “That is a typical practice in situations like this across the country, and they chose not to do that.”
In a statement to Fresnoland, Aldo De La Torre, president of Community’s Insurance Services and Managed Care division, reiterated that retirees may request a “continuity of care” provision for Aetna to receive services.
“We are actively negotiating with Aetna and are committed to reaching an agreement that allows us to continue providing high-quality care at a fair rate,” De La Torre said in the statement. “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.”
That standard, De La Torre said in the statement, hasn’t been met by the terms that Aetna has brought to the bargaining table so far.
“If patients are in active treatment with a Community Health Partners physician, they can request authorization from Aetna for a ‘continuity of care’ provision,” De La Torre said in the statement. “Upon Aetna’s approval, this would allow Community providers to continue services for up to a year for that patient.”
