What type of behavioral health provider is right for me?

Provider Types

What questions should I ask when selecting a behavioral health provider?

Questions to Ask

Understanding Your Behavioral Health Benefits

Seeking Help for Behavioral Health? We're With You.

If you or a family member is ready to seek help for behavioral health, we’re here to make the process as smooth as possible. Because when you get the right care, you’ll feel so much better.

Most of our plans provide coverage for outpatient counseling and inpatient behavioral health services. However, there are exceptions. For example, Tufts Health Plan may not administer these services for some POS and EPO plan members. Please refer to your ID card or call the Tufts Health Plan Behavioral Health Department at 800.208.9565 for more information.

Get Access to the Care You Need1

How to select Outpatient Counseling Providers

1. Check the plan name on your ID Card.

If your ID card says “HMO” and /or “EPO” in the plan name, then you need to see in-network providers for counseling services. You do not need a referral from your Primary Care Provider (PCP)*

If your ID card says “POS” - in the plan name, you can choose to see in-network OR out-of-network providers.

2. Choose a provider.

Log in to mytuftshealthplan.com and select “Doctor Search.”

If your PCP gives you the name of a specific provider, be sure to check the online directory to confirm that he or she is in-network.

You can also call our Behavioral Health Department at 800.208.9565. We’ll be glad to provide a list of providers and their phone numbers based on your needs. You may need to call multiple providers to find one who has openings that fit your schedule.

3. Set up an appointment.

Call the provider and set up your appointment. Your provider is responsible for notifying Tufts Health Plan of your first appointment.

For added convenience, if your plan allows, you may want to consider using our telehealth service powered by Teladoc®. It gives you 24/7 access to an in-network counselor by phone, web or mobile app! Find out more at teladoc.com/tuftshealthplan.

* You do need a referral if you are enrolled in a Tufts Medicare Advantage Plan

What if you're a new member with an existing Outpatient Provider?

1. Look for your provider in our network.

To find a provider, log in to mytuftshealthplan.com and select “Doctor Search”

2. Don’t see your provider on the list?

Call us at 800.208.9565. We’ll contact your provider to recruit him or her into our network. Or we can help find a new in-network provider who will work best for you.

How to access Inpatient Behavioral Health Care

1. Call us at 800.208.9565

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.

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, POS, PPO and EPO members 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.

How to access Inpatient Care for Substance Use Disorder

1. Call us at 800.208.9565

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.

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, POS, PPO and EPO members 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 800.208.9565. We’re with you on the path to better health.

Learn more about treatment for alcohol and substance use disorder.

 

Common Behavioral Health Benefits Questions


1 Behavioral health benefits may not be available to all self-insured members so please confirm with your employer or administrator.

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