1. Call us at the number on your ID card
You or a designated representative can call us to learn what inpatient behavioral health facility is covered under your benefits. Some HMO members are assigned to a specific Tufts Health Plan-contracted inpatient hospital called a designated facility and must receive their care at that facility.
EPO, POS and PPO members are not assigned to a specific facility; they can seek inpatient care at any designated facility and be covered at the authorized level of benefits.
2. Search for a behavioral health facility
Review complete listings of participating behavioral health facilities for commercial plan members.
Tufts Health Plan contracts with inpatient behavioral health facilities that are not on our designated facility list.
HMO members who are not assigned to a designated facility, and PPOmembers can also be covered at the authorized level of benefits at these other participating facilities.
3. Go to the Emergency Room
If you feel you need immediate inpatient care, you can go to the nearest emergency room (ER) for an evaluation. The ER team will then contact Tufts Health Plan to determine the next steps based on your clinical needs and your coverage.
Be aware of out-of-network costs.
POS and PPO members have the option of receiving medically necessary services outside of the Tufts Health Plan network of contracted and designated facilities. However, these members will be covered at the unauthorized level of benefits, which means they will be responsible for paying a deductible and coinsurance for any covered services they receive. In other words, this option will cost them more money out of their own pocket.
Be aware of the types of care.
If your plan has out-of-network benefits, it may seem appealing to attend an out-of-state facility where your troubles seem far away.
However, be careful about out-of-state treatment centers — not all are legitimate. Some are recruiting patients only to offer inadequate care and leave people stranded. The Massachusetts Attorney General warned of out-of-state addiction treatment scams in 2017.
If you need help determining what type of care will work best for you, contact our behavioral health department at the number on your ID card. We’re with you on the path to better health.
Learn more about treatment for alcohol and substance use disorder.