This is to inform you about your Tufts Health Plan benefits for mental health and substance use disorder services
Under both Massachusetts laws and federal laws, benefits for mental health services and substance use disorder services must be comparable to benefits for medical/surgical services. This means that copays, coinsurance and deductibles for mental health and substance use disorder services must be at the same level as those for medical/ surgical services. Also, Tufts Health Plan’s review and authorization of mental health or substance use disorder services must be handled in a way that is comparable to the review and authorization of medical/surgical services.
If Tufts Health Plan makes a decision to deny or reduce authorization of a service, you will receive a letter explaining the reason for the denial or reduction. At your request, Tufts Health Plan will send you or your provider a copy of the criteria used to make this decision.
If you think that Tufts Health Plan is not handling your benefits in accordance with this notification, you may file a complaint with the Division of Insurance (DOI) Consumer Services Section.
You may file a written complaint using the DOI’s Insurance Complaint Form. You may request the form by phone or by mail or find it on the DOI’s webpage.
You may also submit a complaint by phone by calling 877-563-4467 or 617-521-7794. If you submit a complaint by phone, you must follow up in writing and include your name and address, the nature of your complaint, and your signature authorizing the release of any information.
Filing a written complaint with the DOI is not the same as filing an appeal under your Tufts Health Plan coverage. You must also file an appeal with Tufts Health Plan in order to have a denial or reduction in coverage of a service reviewed. This may be necessary to protect your right to continued coverage of treatment while you wait for an appeal decision. Follow the appeal procedures outlined in your Tufts Health Plan benefit document for more information about filing an appeal.