ATTENTION SAINT VINCENT AND METROWEST MEDICAL CENTER PATIENTS

YOUR ACCESS TO CARE MAY BE DISRUPTED IF YOU ARE INSURED BY Point32Health Plan (Tufts/Harvard Pilgrim)

If you’re insured by Point32Health (Tufts / Harvard Pilgrim) and receive care at Saint Vincent Hospital in Worcester and MetroWest Medical Center in Framingham, you may be at risk of network disruption if a new contract is not reached by the end of the year.

If an agreement is not reached in time, Point32Health members will not be able to access our hospitals at in-network benefit levels. This could disrupt trusted physician-patient relationships and place undue financial burdens on families as they could face significantly higher out of network costs or go to a higher cost facility. We encourage you to contact Tufts and Harvard Pilgrim if you have questions about continuity of care benefits and higher out-of-network copays, co-insurance and deductibles that may be applicable.

You can always access our hospitals for emergency services regardless of your health plan. We are here for those with emergency care needs. 

Saint Vincent Hospital and MetroWest Medical Center may no longer be in network with Point32Health (Tufts / Harvard Pilgrim) after January 1, 2025.  For over 6 months, we’ve been trying to renew our contract with Point32Health so we may continue serving Tufts and Harvard Pilgrim members on an in-network basis. 

Saint Vincent Hospital and MetroWest Medical Center are the lower cost high quality option and critical community hospitals for the cities and towns we serve. According to data published by Massachusetts Center for Health Information and Analysis (CHIA), Point32Health plans already reimburse Saint Vincent Hospital and MetroWest Medical Center below the average payment to other Massachusetts hospitals. Saint Vincent is the only alternative to UMASS Memorial Medical Center in Worcester and MetroWest is the only hospital located in Framingham. 

Point32Health is not engaging in good faith discussions to reach an equitable agreement. Point32Health is disregarding inflationary pressures all hospitals face. Point32Health is limiting annual reimbursement increases for certain plans to well below inflation as well as demanding rate reductions for other plans. Meanwhile, Point32Health’s own data shows they continue to increase premiums (the cost to you) and maintained significant reserves of over $1.75 billion in 2023. This is well over the amount required to cover claims.

Point32Health leadership is prioritizing their profits over their Massachusetts members’ network adequacy. Point32Health continues to cite their operating loss for the reason for unfair reimbursement despite the fact they continue to increase premiums (the cost to you). Their interim CEO does not reside in Massachusetts and is putting Worcester and Framingham communities at risk of losing in-network access to critical hospitals. 

This website includes additional information and will be updated based on the status of ongoing negotiations.

About Our Critical Services

Saint Vincent Hospital and MetroWest Medical Center have the privilege of caring for nearly 50,000 Point32Health (Tufts / Harvard Pilgrim) patient encounters annually, providing access to critical healthcare services for the communities we serve.

Saint Vincent Hospital

Saint Vincent is the only alternative hospital to UMass Memorial Medical Center with similar range of higher acuity services, serving the greater Worcester community.

Saint Vincent is the lower-cost hospital alternative to UMass Memorial Medical Center, providing access to comprehensive services including cardiovascular, oncology, stroke, women’s health and behavioral health.

U.S. News & World Report Recognized Saint Vincent Hospital as a “Best Hospital” for 2024-25 and it placed eleventh overall among Massachusetts hospitals. Saint Vincent Hospital also earned “High Performing” ratings for its exceptional care of patients in multiple specialties, including COPD, heart attack, heart failure, kidney failure and knee replacements.

Saint Vincent was named #1 in Massachusetts for Cardiology, and for the second year in a row, named one of America’s 100 Best Hospitals for Coronary Intervention, according to new research released by Healthgrades. 

 

MetroWest Medical Center

MetroWest Medical Center is the only acute care hospital located in Framingham. 

Leonard Morse is our dedicated behavioral health campus providing critical access to treatment for patients throughout the Commonwealth.

MetroWest provides the only cardiovascular catheterization services for the greater community and was named One of America’s Best Coronary Intervention Hospitals by Healthgrades in 2023, placing it among the top 5% in the nation for coronary interventional procedures, and a 5-star recipient for treatment of pulmonary embolism by Healthgrades in 2024.

MetroWest was named a Blue Cross Blue Shield Distinction Center for Maternity Care, Bariatric Surgery and Knee and Hip Replacement.

What Actions Can You Take?

We understand the importance of maintaining access to the hospitals you know and trust. There may be options for you to consider maintaining in-network access to Saint Vincent Hospital and MetroWest Medical Center. We are currently in-network with all other major health plans.

If you have Tufts or Harvard Pilgrim coverage through your employer: We encourage you to call your employer’s human resources team to discuss the impact of losing in-network access. If your employer offers other health benefit plans, consider switching to a plan that includes Saint Vincent Hospital and MetroWest Medical Center in its network. Our hospitals are in-network with all other major health plans including BCBS Massachusetts, United, Aetna and more. 

If you have Medicare coverage through Tufts or Harvard Pilgrim: We encourage you to call 1-800-MEDICARE or visit www.Medicare.gov to enroll in another plan. We encourage you to consult with your broker or caregiver to find out about alternative insurance options that may be available to you during the Medicare Annual Enrollment Period which begins October 15, 2024, and ends December 7, 2024.

If you have Medicaid coverage through Tufts or Harvard Pilgrim:  We encourage you to call the Massachusetts Health Connector at 1-877-623-6765 or visit www.mahealthconnector.org/get-ready-to-enroll to enroll in another plan. Open enrollment period for Massachusetts Medicaid begins November 1, 2024. 

If we do not reach an agreement with Tufts and Harvard Pilgrim, you may qualify for Continuity of Care benefits for a period of time if you need ongoing treatment or already have a procedure scheduled.

Call the customer service phone number on the back of your Tufts or Harvard Pilgrim health insurance card regarding any questions about your benefits coverage.

Frequently Asked Questions

What are these negotiations about?

A large insurer in the state, Point32Health (Tufts / Harvard Pilgrim), has been in discussions with Saint Vincent Hospital and MetroWest Medical Center on a renewal of its contract to cover patient care reimbursements at the two hospitals.

Why have Point32Health (Tufts / Harvard Pilgrim) and the hospitals not reached an agreement?

Point32Health (Tufts / Harvard Pilgrim) is not willing to negotiate in good faith or offer fair reimbursement for critical hospital services provided by Saint Vincent Hospital and MetroWest Medical Center despite the significant inflationary pressure and workforce shortages faced by hospitals across the Commonwealth. 

Why is Point32Health (Tufts / Harvard Pilgrim) not working quickly with the hospitals to reach a fair agreement?

We do not know why Point32Health is not willing to engage in good faith negotiations. As of mid-October, Point32Health has not agreed to in-person discussions so we can make progress towards a fair agreement. We are disappointed as we’ve successfully reached fair agreements with every other major insurance company.

Why is the proposed reimbursement not adequate?

Point32Health plans already reimburse Saint Vincent Hospital and MetroWest Medical Center well below the average payment to peer Massachusetts hospitals (in fact, 10 percent and 20 percent less, respectively). Point32Health’s recent proposal disregards inflationary pressures all hospitals in the Commonwealth face. If our hospitals accept the unfair reimbursement, the hospitals will be required to evaluate capacity and service reductions.

What would be the impact if no agreement is reached in time?

Saint Vincent and MetroWest would not be able to provide in-network care to any patients with Point32Health (Tufts / Harvard Pilgrim) coverage. This would include procedures, OB deliveries, cancer treatment and more. The sole exception would be the Emergency Department, which would still treat those with Point32Health (Tufts / Harvard Pilgrim).

My family and I are covered by Point32Health (Tufts / Harvard Pilgrim).  How would this affect me?

If an agreement is not reached in time, Point32Health (Tufts / Harvard Pilgrim) members will no longer be able to access Saint Vincent Hospital and MetroWest Medical Center at in-network benefit levels. This could disrupt trusted physician-patient relationships and place undue financial burdens on families as they could face significantly higher out of network costs. Please know you can always access our hospitals for emergency services regardless of your health plan.

Would I still be able to see my current doctor?

Individual doctors and practices reach their own contracts with insurers. If your doctor uses Saint Vincent or MetroWest for out-patient diagnostics, procedures, or in-patient care, they would not be able to continue to do so after the contract expires.  We recommend consulting your doctor if you have questions or concerns.