Coverage for out-of-network urgent care services

Learn more about temporary expanded access to urgent care beginning July 3, 2024

In an effort to ease overburdening within hospital emergency departments across Eastern Massachusetts, the Executive Office of Health and Human Services (EOHHS) is temporarily expanding member access to medically necessary urgent care services.

For dates of service from July 3, 2024 through Oct. 1, 2024, Point32Health will provide coverage for services rendered at out-of-network urgent care clinics in Eastern Massachusetts for fully-insured Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, Tufts Health Direct, Tufts Health Together, Tufts Health One Care, and Tufts Health Senior Care Options (SCO) plan members.

Expanded coverage for the state’s initiative includes out-of-network urgent care clinics located in Essex, Middlesex, Suffolk, Norfolk, Bristol, Plymouth, Barnstable, Dukes, and Nantucket counties. For additional details on this temporary measure, please refer to MCE Bulletin 119 and a recent Massachusetts Memorandum.

For claims submission guidance, providers are encouraged to refer to their patients’ member ID cards as well as Point32Health’s Provider Manuals. Please keep in mind that urgent care clinics are not permitted to balance bill members during this time period.

We’re pleased to help with the effort to redirect patients to urgent care when emergency-level care is not necessary and are hopeful that this initiative will reduce emergency department overcrowding during the coming months.