FUSD explore other health care options as talks between Community Medical, Aetna remain stalled

FRESNO, Calif. (KFSN) -- With uncertainty surrounding the security sum for thousands of Fresno Unified retirees, erstwhile employees are seeking answers from territory leaders.

"I consciousness atrocious for immoderate of these retirees 80, 90, similar my neighbor, who went to the doc and they told her, "you can't travel here,"" said erstwhile Fresno Unified teacher, Nancy Lind.

She is conscionable 1 of implicit 6,000 retirees dealing with cancelled appointments and indispensable services denied since the commencement of the caller year.

The struggles travel arsenic a effect of stalled negotiations betwixt Community Medical Centers and security institution Aetna, leaving retirees without in-network entree to the Community Health System.

Educational leaders pointed to the providers connected Monday.

"Folks request to recognize that it is Community that tin bash this close now, by conscionable accepting radical and billing Aetna, they are choosing not to bash this," said Fresno Teachers Association President Manuel Bonilla.

Instead, Community Medical has suggested that those affected use for a "continuity of care" provision.

Explaining successful a statement:

"Upon Aetna's approval, this would let Community providers to proceed services for up to a twelvemonth for that patient."

But Fresno Unified says the proviso is not a cure-all.

"Its lone for a fewer radical nether progressive treatment, truthful evidently our benefits section stands acceptable and has been reaching retired to retirees that person those concerns," said Chief Financial Officer Patrick Jensen.

Many retirees person besides been told by Community to look for alternate providers, but that solution comes with out-of-pocket costs astir can't afford.

"That unluckily has been the alternative, and wherefore we are pressing truthful hard contiguous connected either having Community widen the declaration and/or measure Aetna," Jensen Explained

Bonilla doubled down connected Community's deficiency of action, saying, "To beryllium perfectly clear, Community Regional Medical has an option, and has ever had an option, to proceed to supply services to our retirees during this dialog process."

The afloat connection from Community Medical Division President of Insurance Services & Managed Care Aldo De La Torre reads arsenic follows,

"Community Health System shares the interest and vexation Fresno Unified educators, retirees, and their families are experiencing astatine the menace of losing in-network entree to our hospitals and providers.

We are actively negotiating with Aetna and are committed to reaching an statement that allows america to proceed providing high-quality attraction astatine a just rate. Our quality to supply high-quality, accessible attraction to the full assemblage depends connected contracts that reasonably reimburse physicians, nurses, and attraction teams for the services they deliver. To date, Aetna has not offered presumption that conscionable that standard. We stay acceptable and anxious to scope an statement that preserves entree for each Aetna members successful our region, including Fresno educators and allied professionals.

If patients are successful progressive attraction with a Community Health Partners physician, they tin petition authorization from Aetna for a 'continuity of care' provision. Upon Aetna's approval, this would let Community providers to proceed services for up to a twelvemonth for that patient."

Superintendent Misty Her has announced that the Joint Health Management Board volition conscionable connected Thursday, January 15, to sermon alternatives that supply the retirees with the due care.