Helping Individuals and Families Find Solutions to Addiction

How Tufts Health Plan is helping members and families

March 01, 2018  

The opioid epidemic has brought pain and suffering to thousands of families in New England and across the country. In fact, of more than 64,000 drug-overdose deaths in the U.S. in 2016, approximately three-fourths were caused by opioids, according to the Centers for Disease Control and Prevention. This class of drugs includes prescription painkillers, heroin and potent synthetic versions like fentanyl. Tufts Health Plan recognizes that substance use disorder (SUD) is a serious medical condition that can be treated. The insurer is reaching out to connect individuals and their loved ones with local support and services that provide hope and address this growing problem.

Following Best Practices

Unfortunately many people who struggle with opioid addiction don’t receive quality care because they don’t know where to get help, what kind of treatment is likely to be best for them or what their insurance covers. But the good news is that treatment outcomes for SUD can be as positive as they are for other chronic medical conditions—when best practices are followed.

At Tufts Health Plan, a Case Management Program provides assistance to members and families coping with SUD. Clinicians at Tufts Health Plan:

  • Perform specialized assessments telephonically
  • Link members to effective care
  • Assist with coordinating services among the multiple practitioners and specialties involved in treatment, and
  • Help members stay engaged in their plan of care.

Navigators Help Families Understand Their Options

In 2016, in response to the opioid epidemic, Tufts Health Plan created a new position: the SUD Navigator. Complementing the work of the Case Management Program, the Navigators help members and their families:

  • Understand addiction, treatment options, and benefits and coverage
  • Make decisions about next steps
  • Find solutions that fit their situation.

Broad Coverage of Treatment Options

Tufts Health Plan fully insured products cover a broad range of treatment options for SUD. Many of its self-insured groups offer the same benefits as well, with coverage for:

  • Inpatient detoxification and acute residential treatment
  • Partial hospital programs and intensive outpatient programs
  • Outpatient therapy and medication management
  • Medication-assisted treatment, including methadone maintenance and prescription of Suboxone
  • Pharmacy coverage for medications used to treat addiction, and for medications that can reverse an opioid overdose

An Unsettling Trend

Many employers have noticed that employees or dependents struggling with addiction are traveling out-of-state to try to get treatment. Many times, they have a desire to receive care far away from the environment in which the problems are occurring. In addition, individuals are trying to recruit New England residents with SUD to travel to so-called treatment centers in Arizona, California or Florida. The recruiters often use texts or social media to lure patients--and may offer to pay for airfare and health insurance to cover the costs of out-of-state treatment. Unfortunately many of the out-of-state programs end up generating inpatient, outpatient and laboratory expenses many times greater than those of local programs. And in some cases, they are scams, offering little or no treatment to patients.

Local Care is the Best Option

The local treatment delivery system offers many quality programs that are well known to local physicians, behavioral health practitioners and the health insurance plan. For SUD treatment to be successful, the patient’s personal support system must be involved and the patient must stay engaged over time. These things are much more likely to occur when services are received close to home rather than out-of-state.

Tufts Health Plan has a deep, broad contracted network of SUD facilities, programs, and practitioners located throughout our service area of Massachusetts, Rhode Island and New Hampshire. They include:

  • An ambulatory network that has added more than 100 additional licensed alcohol and drug counselors over the past year.
  • Providers who specialize in, and adhere to, evidence-based practices in the care of SUD patients.

For information about Tufts Health Plan’s Case Management Program for SUD, or to speak to a SUD Navigator, members should call 1-800-208-9565. For help with finding a SUD provider, members should call the member services phone number on their ID card.



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