BOSTON – Thousands of patients at Boston Children’s Hospital, UMass Memorial and Tenet hospitals may have to find new doctors after the hospitals failed to reach an agreement with Point32Health, the state’s second-largest health insurer.
Who is affected by the change?
The change mainly affects those participating in Tufts Health Direct, a subsidized program offered through the state’s Health Connector. Point32Health owns Tufts Health Plan and Harvard Pilgrim Health Care.
All affected members received letters on Tuesday informing them of the changes, which will affect more than 20,000 patients.
No agreement with Children’s or UMass
According to Point32Health, it was unable to reach an agreement with UMass Memorial Health and Children’s Hospital for Tufts Health Direct members.
“These providers have determined that for one product, Tufts Health Direct, they cannot accept the rate necessary to provide affordable coverage to these individuals who receive premium support due to low income. It is our responsibility as the Commonwealth to improve the affordability of these products guarantee this population,” Point32Health said in a prepared statement.
Children’s Hospital said there will be a continuity period for those who receive their primary care at Children’s Hospital, and patients will be able to see their current in-network doctor until January 30, 2023.
Negotiations are ongoing with Tenet
Point32Health said the company is still in negotiations with Tenet Healthcare, owner of MetroWest Medical Center in Framingham and St. Vincent Hospital in Worcester, over provider reimbursement, claiming that “Tenet has demanded significant rate increases each year in the term of a multi-year contract.”
What’s next for patients?
The company said it plans to continue negotiations with Tenet and hopes to reach an agreement before the contract expires on December 31.
Massachusetts Health Connector open enrollment runs from November 1 through January 23, 2025. During open enrollment, patients can select and enroll in a different health plan if they do not want to switch doctors.
