Fresno Unified retirees filed a class action lawsuit against the school district, alleging it caused serious harm to retirees’ health and well-being by switching retirees’ healthcare plan to a Medicare Advantage plan in 2023.
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The lawsuit, filed by Emily Brandt, a retired Bullard High School English teacher, represents a class of 6,200 retirees. The suit accuses Fresno Unified of failing to engage active employees and retirees in the decision-making process in 2023 to change the health benefit plan from the traditional Medicare plus a district-paid self-funded secondary insurance to a for-profit Aetna Medicare Advantage plan.
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The impact of this change surfaced earlier this year when Community Health System, Fresno area’s largest network of clinics and hospitals, fell into a network dispute with Aetna’s Medicare Advantage, leaving retirees with limited or no access to their primary healthcare services for a month.
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The network dispute was settled in early February, and retired employees regained full access to the services provided by Community Health System. Additionally, the district’s Joint Health Management Board agreed to give retirees the option to enroll in a plan similar to what was offered prior to 2023, which consists of enrolling in traditional Medicare with a preferred provider organization, or PPO, plan as a secondary insurance. The option will not be available until January 2027.
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But some retirees remained dissatisfied with the district’s resolution. After switching to Medicare Advantage, some retirees said they experienced a more restricted provider network, increased red tape, and higher referral and denial rates.
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As a result, a group of retirees sent a complaint letter in late January demanding that Fresno Unified cease Aetna’s Medicare Advantage plan, restore the health insurance model promised in the collective bargaining contract, and compensate retirees for losses incurred during the month-long disruption.
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Fresno Unified responded three days later in a statement that the complaint letter was “baseless and misleading.”
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“We want to be absolutely clear: qualified retirees are receiving and will continue to receive health insurance coverage,” the district’s statement wrote on Jan. 26. “The district’s commitment to retiree health benefits has not been eliminated, reduced, or revoked. Everything that was promised to retirees in recognition of their years of service remains intact and continues to be honored today.”
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Fresno Unified officials did not comment on the lawsuit, citing the district’s policy not to discuss ongoing litigation.
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The class action lawsuit filed this week reiterated retirees’ complaints and claim appointments, treatments, surgeries, and other complex critical care were terminated during the disruption.
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Brandt, the main plaintiff, and Kevin G. Little, the lawyer who represents retirees in the lawsuit said in Fresno Unified has not announced any procedures for retirees to opt out of their current Medicare Advantage plan and return to traditional Medicare, which has caused distress and fear for retirees
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Retirees feel betrayed by their former employer as Fresno Unified defiantly dismissed the harm caused by healthcare plan changes and the subsequent disruption, Brandt and Little said in a statement.
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