Choosing a Primary Care Provider
So now that you know a bit more about the fee structure of the CareLink plan, how do you actually use it to visit a doctor?
The CareLink plan gives you the freedom to visit the health care provider you want. You may visit a Primary Care Provider (PCP), or you can visit a specialist. No referral is required.
When you choose a doctor, you should also consider whether that doctor is in the CareLink network or not. Take a look at our provider directory to view the network. As mentioned, the CareLink network is nationwide and includes thousands of high-quality physicians and hospitals.
Visit the CareLink provider directory
With many plans, you need a referral from a Primary Care Provider (PCP). And while we certainly encourage you to regularly visit a PCP, the CareLink plan does not require a referral from a PCP. That means you may visit any specialist you like, subject to the copays, deductibles and guidelines already mentioned. As always, you can find out exactly what your specific plan covers by reading your Benefit Document or accessing your secure member account at mytuftshealthplan.com.
In-network Doctor Visits
If you choose to use a doctor in the CareLink network for covered services, your office visit will be covered in full, with the exception of any copay your plan requires. Any covered services the doctor provides that are subject to a deductible will be covered in full once your deductible has been met.
Cost-wise, choosing a CareLink doctor will result in the lowest out-of-pocket costs possible.
Out-of-network Doctor Visits
If there’s a doctor who’s not in the CareLink network, but provides a covered service, you can still see them. The out-of-network service may be subject to a deductible and co-insurance. If you’ve already met your deductible, you may have to pay a percentage, up to your out-of-pocket maximum.
Choosing an out-of-network doctor will provide you with maximum flexibility, but with higher out-of-pocket costs.