BOSTON – Thousands of patients at Boston Children’s Hospital, Massachusetts Memorial Hospital and Tenet Hospital may have to find new doctors after the state’s second-largest health insurer, Point32 Health, failed to reach an agreement. .
Who is affected by this change?
The change primarily affects those using Tufts Health Direct, a subsidy program offered through the state’s Health Connector. Point32Health owns Tufts Health Plan and Harvard Pilgrim Health Care.
All affected members received a letter on Tuesday informing them of the change, which affects more than 20,000 patients.
No agreements with Children’s or UMass
Point32Health said it was unable to reach an agreement with members of UMass Memorial Health and Children’s Hospital for Tufts Health Direct.
“These providers have determined that the Tufts Health Direct product is unacceptable to them at the rates necessary to provide affordable coverage to individuals receiving premium support due to low incomes. It is our responsibility as a federation to provide these products at affordable prices for the “population,” Point32Health said in a prepared statement.
Children’s Hospital said there will be a continuation period for patients receiving primary care at Children’s Hospital, allowing patients to see their current physician within the network until January 30, 2023.
Negotiating with Tenet
Point32 Health said the company is still in negotiations over provider reimbursement with Tenet Healthcare, which owns MetroWest Medical Center in Framingham and St. Vincent Hospital in Worcester. They demanded a price increase.” . ”
What’s next for patients?
The company said it plans to continue negotiations with Tenet and hopes to reach an agreement by December 31, when the contract expires.
Open enrollment for the Massachusetts Health Connector will run from November 1 to January 23, 2025. During open enrollment, patients can choose and enroll in a different health plan if they do not want to change doctors.
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