Over 20,000 Massachusetts patients may lose their doctors amid insurance dispute

By Hannah Goeke

Over 20,000 patients in Massachusetts may need to find new doctors because hospitals could not reach a deal with a major health insurer, Point32Health. This mainly affects people enrolled in Tufts Health Direct, a program designed for low—to moderate-income individuals, including Boston Children’s Hospital and UMass Memorial. 

Point32Health, the state’s second-largest insurer, announced that these hospitals decided they couldn’t accept the payment rates needed to keep coverage affordable for patients. All affected members received letters on Tuesday informing them of the changes. While patients will still be able to see their current doctors until January 30, 2025, they may have to switch providers if no agreement is reached.

Dr. Eric Dickson, chief executive of UMass Memorial, said that Point32Health wanted to pay a lower reimbursement rate than UMass Memorial could afford.“We would have lost money on every patient we saw and every patient we hospitalized and every patient we operated on,” said Dickson.

The number of patients affected could increase to nearly 40,000 if Point32Health does not reach an agreement with Tenet Healthcare, which owns three other local hospitals, by the end of the year. Point32Health stated that Tenet has demanded significant rate increases every year. 

“We understand that as a publicly traded company, Tenet has different priorities than ours, putting shareholders and executives first. Tenet’s stock price rose more than 75 percent in 2023, while the company provided its CEO with more than $18 million in compensation,” said Point32Health in an official statement. Shelly Weiss Friedberg, a Tenet spokesperson, denied the healthcare company sought double-digit increases. 

For those impacted, enrollment for health plans will be open from November 1 to January 23, 2025, allowing patients to choose a different plan if they want to keep their current doctors.