Insurance dispute in Massachusetts may force thousands of patients to find new doctors
BOSTON - Thousands of patients at Boston Children's Hospital, UMass Memorial and Tenet hospitals may need to find new doctors after the hospitals failed to come to an agreement with the second-largest health insurer in Massachusetts, Point32Health.
Who is impacted by the change?
The change primarily impacts those on Tufts Health Direct, a subsidized program that is offered through the state's Health Connector. Point32Health owns Tufts Health Plan and Harvard Pilgrim Health Care.
All affected members received letters on Tuesday notifying them of the changes, which will impact 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 Boston Children's Hospital for Tufts Health Direct members.
"These providers determined that for one product, Tufts Health Direct, they cannot accept the rate necessary to offer affordable coverage to these individuals who receive premium support due to low income. It is our responsibility as a Commonwealth to ensure affordability of these products for 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 there and patients will be able to see their current physician in-network until January 30, 2025.
Negotiations ongoing with Tenet
Point32Health said the company is still in negotiations with Tenet Healthcare, which owns MetroWest Medical Center in Framingham and St. Vincent Hospital in Worcester, over provider reimbursement, claiming "Tenet has demanded significant rate increases every year over the course of a multi-year contract."
What's next for patients?
The company said it plans to continue negotiating with Tenet and hopes to reach an agreement before the contract expires on December 31.
Massachusetts Health Connector's open enrollment runs from November 1 to January 23, 2025. During open enrollment, patients can select and enroll in another health plan if they do not want to switch doctors.