Tufts Health Direct Provider Network Changes -UMass Memorial Health & Children's Hospital Boston Effective January 1, 2025

As of January 1, 2025, UMass Memorial Health and Children’s Hospital Boston will no longer be contracted as in-network providers for Tufts Health Direct. This includes UMass Memorial Health and Children’s Hospital Boston’s inpatient and outpatient facilities and locations, primary care physicians (PCPs), specialists, certain on-site laboratory services, behavioral health clinicians and other ancillary services. This change is for all Tufts Health Direct plans, including individual and small group plans sold through HSA Insurance and the Massachusetts Health Connector.

If you are enrolled in a Tufts Health Direct Individual & Family Plan through HSA Insurance, your plan renews on January 1, 2025. Please consider your provider needs as you prepare for and during your upcoming renewal period beginning November 1, 2024, through December 23, 2025. If your provider will no longer be in the Tufts Health Direct network, we offer many choices from several other carriers.

If you are a sole proprietor or small group employer enrolled in a Tufts Health Direct small group plan renewing on a date other than January 1, 2025, please keep in mind that you may switch carriers off renewal through HSA Insurance, however all accumulators will reset.

The team at HSA Insurance is here to assist you as you consider your health insurance coverage options. Please give or Customer Service team a call at 781.228.2222 if you have any questions or require assistance.

Tufts Health Direct has shared the following information with HSA Insurance regarding the change:

We have been engaged in standard contract discussions with several provider groups and facilities over the last several months. Despite our best efforts, we were unable to reach an agreement on a new contract with UMass Memorial Health and Children’s Hospital Boston for our Tufts Health Direct members who purchase their insurance through the Massachusetts Health Connector or HSA Insurance. These changes become effective at midnight on December 31, 2024.

The decision to terminate providers from any of our product networks is never made lightly, as we know changes like this can be difficult for our members. Our goal is to always provide our members access to with high-quality, affordable coverage, and the payment rate demands from these provider groups were not sustainable. At this time our top priority is to minimize the potential disruption of care for our members who will be impacted by these changes. All of the affected members will receive a letter notifying them of the changes and how to select a new PCP or specialist if applicable, or other options as needed.

Questions & Answers

UMASS Memorial Health & Children's Hospital Boston

QUESTIONS	ANSWERS
What is happening to UMass Memorial Health/Children’s Hospital Boston as a provider in Tufts Health Direct plans, and when?	As of January 1, 2025, UMass Memorial Health and Children’s Hospital Boston will no longer be contracted as in-network providers for Tufts Health Direct. This includes UMass Memorial Health and Children’s Hospital Boston’s inpatient and outpatient facilities and locations, primary care physicians (PCPs), specialists, certain on-site laboratory services, behavioral health clinicians and other ancillary services.
Does this change for UMass Memorial/Children’s Hospital Boston affect any other products?	No, It does not affect: Harvard Pilgrim or Tufts Health Plan’s Commercial Plans, where members receive their health insurance through their employer. MassHealth (Medicaid ACO) members. Harvard Pilgrim’s products. Medicare members. Dually eligible members (Senior Care Options (SCO) and One Care (Tufts Health One Care).
Why is UMass Memorial/ Children’s Hospital Boston terminating?	The decision to terminate a provider organization from any of our product networks is never made lightly, as we know changes like this can be difficult for our members. However, in order to keep this product as affordable as possible, the demands from the providers were not sustainable, as a significant portion of our Tufts Health Direct membership.
Is there any difference if a member is enrolled through the Health Connector or HSA Insurance?	No. This change is for all Tufts Health Direct plans, regardless of how a member enrolled in the plan.
How many members are impacted?	There are approximately 16,841 members (8.2 percent of the THP Direct membership) who are assigned to a UMass Memorial Health/Children’s Hospital PCP in Tufts Health Direct.
What options do members have?	All of the impacted members will receive a letter notifying them of this change and how to select a new PCP or specialist if applicable, or a new plan. For members enrolled through their employer in Tufts Health Direct, they should contact their employer to discuss the timing of their own open enrollment period, and the selection of a plan which includes UMass Memorial Health/Children’s Hospital Boston as in-network.
What steps are UMass Memorial Health/Children’s Hospital Boston and Tufts Health Plan taking to communicate the impact of this network change to members?	UMass Memorial Health/Children’s Hospital Boston and Tufts Health Plan are sending notifications to members alerting them to this network change. All of the impacted members will receive/have received a letter notifying them of this change and how to select a new PCP or specialist if applicable, or a new plan. The letters will be mailed before October 31, 2024. Members who take no action, but remain enrolled in their plan, will be assigned a new PCP and receive a second letter before January 1, 2025, informing them of their newly assigned PCP.
How will this network change be reflected in the HSA Insurance and Tufts Health Plan provider directories?	As of November 1, 2024, the HSA Insurance online directory will not show UMass Memorial Health/Children’s Hospital Boston providers in-network for Tufts Health Direct. Similarly, as of November 1, 2024, the Tufts Health Direct provider directory will not show UMass Memorial Health/Children’s Hospital Boston providers in network. However, the Tufts Health Direct provider directory will include disclosures that UMass Memorial Health/Children’s Hospital Boston providers remain in network through December 31, 2024.
What does this mean for members who are receiving care from a UMass Memorial Health/Children’s Hospital Boston PCP?	Current Tufts Health Direct members receiving care from their UMass Memorial Health/Children’s Hospital Boston PCPs, and who continue to be enrolled in a Tufts Health Direct plan into 2025, will be able to continue to see that provider through January 30, 2025. In certain cases, members may be able to see their provider for a longer period of time (see “Continuity of Care” Question & Answer sections below).
What options exist for individual members (i.e., members not enrolled as part of a small group) who have a UMass Memorial Health/Children’s Hospital Boston PCP?	If a member wants to stay enrolled in their current Tufts Health Direct plan, they can select a new PCP (as they can at any time), by calling Tufts Health Plan @ 888.257.1985, or online at tuftshealthplan.com/memberconnect. If a Tufts Health Direct member wants to continue to see their UMass Memorial Health/Children’s Hospital Boston PCP, they will need to enroll in a new plan that includes UMass Memorial Health/Children’s Hospital Boston, during the Open Enrollment period. The member can select a new plan through HSA Insurance. The member can log into their client portal at www.HSAinsurance.com or contact the HSA Insurance Customer Service Team at 781.228.2222 for assistance.
What will happen to members on individual plans who are affiliated with a UMass Memorial Health/Children’s Hospital Boston, if they take no action?	The member will continue to remain enrolled in Tufts Health Direct plan and will be assigned to a new PCP and notified via mail before January 1, 2025. Members will be assigned to PCPs near where live, and that have open panels.
What options exist for members who are enrolled in Tufts Health Direct as part of a small group and have a UMass Memorial Health/Children’s Hospital Boston doc?	Members enrolled in a small group plan will no longer be able to be assigned to their PCP beginning on January 1, 2025 and will no longer be able receive care from that PCP after January 30, 2025, with the exception of certain scenarios outlined below in the “Continuity of Care” Questions and Answers sections. Members can select a new PCP, by calling Tufts Health Plan @ 888.257.1985, or online @ tuftshealthplan.com/memberconnect. If a member already has an appointment after 1/30/25, including an appointment that requires a prior authorization, the member should contact their UMass Memorial Health/Children’s Hospital Boston office to confirm the provider is able to render services. These providers will coordinate payment approval from Tufts Health Plan. When the member’s employer chooses a plan as part of its annual health plan renewal process, they can choose a plan which has UMass Memorial Health/Children’s Hospital Boston providers in network, and the member can once again receive care from their UMass Memorial Health/Children’s Hospital Boston PCP. However, this will only be possible when the employer sponsor’s current plan year is over, which could be any month of the year. Members should contact their employer with questions about their plan year, and/or their employer’s choice of health plan enrollment.
What does this mean for members who are receiving care from a UMass Memorial Health/Children’s Hospital Boston specialist?	Members receiving care from their UMass Memorial Health/Children’s Hospital Boston specialist, and who continue to be enrolled in a Tufts Health Direct plan into 2025, will be able to continue to see that provider through January 30, 2025. In certain cases, members may be able to see their provider for a longer period of time (see “Continuity of Care” Question & Answer sections below).
What options exist for individual members (i.e., members not enrolled as part of a small group) who are seeing a UMass Memorial Health/Children’s Hospital Boston specialist?	If a member wants to continue to be enrolled in their current Tufts Health Direct plan, or another Tufts Health Direct plan, they can search the specialists in their area by using the Find a Doctor, Hospital or Pharmacy tool at tuftshealthplan.com/directproviders. They can also call Tufts Health Plan at 888.257.1985 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. If a Tufts Direct member wants to continue to see their UMass Memorial Health/Children’s Hospital Boston specialist, they will need to enroll in a new plan that includes their provider during the Open Enrollment period. The member can select a new plan through HSA Insurance. The member can log into their client portal at www.HSAinsurance.com or contact the HSA Insurance Customer Service Team at 781.228.2222 for assistance.
What options exist for members who are enrolled in Tufts Health Direct as part of a small group and have a UMass Memorial Health/Children’s Hospital Boston specialist?	Members enrolled in a small group plan will no longer be able to receive care from their UMass Memorial Health/Children’s Hospital Boston specialist after 1/30/25, with the exception of certain scenarios outlined below in the “Continuity of Care” Questions and Answers sections. Members can find a new specialist using the Find a Doctor, Hospital or Pharmacy tool at tuftshealthplan.com/directproviders, or by calling Tufts Health Plan at 888.257.1985 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m. If a member already has an appointment after 1/30/25, including an appointment that requires a prior authorization, the member should contact their UMass Memorial Health/Children’s Hospital Boston office to confirm the provider is able to render services. UMass Memorial Health/Children’s Hospital Boston will coordinate payment approval from Tufts Health Plan. When the member’s employer chooses a plan as part of its annual health plan renewal process, they may choose a plan which has UMass Memorial Health/Children’s Hospital Boston providers in network, and the member can once again receive care from their specialist. However, this will only be possible when the employer sponsor’s current plan year is over, which could be any month of the year. Members should contact their employer with questions about their plan year, and/or their employer’s choice of health plan enrollment.
What will happen to members who are affiliated with a UMass Memorial Health/Children’s Hospital Boston specialist if they take no action?	When booking an appointment for any date after January 30, 2025, members will be informed by UMass Memorial Health/Children’s Hospital Boston that they are no longer accepting Tufts Health Direct. This member will need to find a new specialist who is in network for Tufts Health Direct. Members can find a new specialist using the Find a Doctor, Hospital or Pharmacy tool at tuftshealthplan.com/directproviders, or by calling Tufts Health Plan at 888.257.1985 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m.
Continuity of Care: Can members see their UMass Memorial Health/Children’s Hospital Boston PCPs and specialists after December 31, 2024?	For current members (and those members who enroll for December 2024) who are continuously enrolled with Tufts Health Direct, they will be able to see their PCPs and specialists at UMass Memorial Health/Children’s Hospital Boston until January 30, 2025. In certain cases (see examples below), members may be able to see their provider for a longer period of time. If a current member disenrolls from their plan in December 2024, and chooses to re-enroll in January (i.e., there is a gap in their Tufts Health Direct coverage), they will no longer be able to select a UMass Memorial Health/Children’s Hospital Boston PCP or receive care from these provide systems’ specialists.
Continuity of Care (continued): When can a member see their UMass Memorial Health/Children’s Hospital Boston providers after January 30, 2025?	For members who are enrolled with Tufts Health Direct as of December 31, 2024, and whose coverage is continuous into 2025, that are seeing UMass Memorial Health/Children’s Hospital Boston PCPs or Specialists, they will be able to continue seeing their providers after January 30, 2025, in the following scenarios: If the member is in a hospital as inpatient. The member may continue to see their providers until discharge from the hospital or until alternative arrangements have been made. If the member is undergoing a course of outpatient treatment, the member may continue to receive care from their providers until the treatment is completed. Members should contact their provider office to confirm their provider is able to render services. UMass Memorial Health/Children’s Hospital Boston will coordinate payment approval from Tufts Health Plan. For members who are at least three months pregnant (i.e., starting their fourth month, or second trimester, based on expected due date), they can keep seeing their current OB/GYN until they have the baby and have a follow-up checkup within the first six weeks after delivery. For members receiving ongoing covered treatment or management of chronic or acute conditions (such as dialysis, home health, chemotherapy and radiation), they may continue to see their UMass Memorial Health/Children’s Hospital Boston providers for up to 90 Days (3/31/25), including previously approved services or Covered Services. Members should contact their provider office to confirm their provider is able to render services. UMass Memorial Health/Children’s Hospital Boston will coordinate payment approval from Tufts Health Plan. Members who are terminally ill and in active treatment, may continue to see their providers.
Can members go see their providers without prior approval, or do they need to contact Tufts Health Plan, after December 31, 2024?	For any care on or after January 1, 2025, that would have otherwise required a Prior Authorization, those requirements will remain in place. This is business as usual. For any care on January 31, 2025, or later, the same Prior Authorization requirements will remain in place, however, members should contact their UMass Memorial Health/Children’s Hospital Boston provider office to confirm their provider is able to render services as part of Continuity of Care. UMass Memorial Health/Children’s Hospital Boston will coordinate payment approval from Tufts Health Plan, in addition to following the normal Prior Authorization procedures.