Understanding Your Behavioral Health Benefits

Seeking help for behavioral health concerns? We can help.

If you or a covered family member is suffering from a behavioral health (BH) (mental health or substance use disorder) condition, we’ll help you get the right care. Your plan covers outpatient counseling, and inpatient mental health and substance use disorder services.

Here’s how to get the care you need:

Outpatient counseling services

1. Stay in-network

You need to see a Tufts Health Direct in-network provider for counseling services. You do not need a referral from your primary care provider (PCP). But your PCP may be able to help you find a professional who offers services near you.

2. Choose a provider

Visit our provider search tool to see a list of in-network providers in your area. If your PCP gives you the name of a specific provider, make sure he or she is a Tufts Health Direct in-network provider.

You can also call our member services team at 888-257-1985 (TTY: 711). We can get you a list of providers and their phone numbers based on your needs.

3. Make an appointment

Call a provider and make an appointment. You may need to call a few providers to find one who has openings that fit your schedule. Your provider is responsible for notifying Tufts Health Plan of your appointments.

Inpatient care for mental health or substance use disorder

Emergency care

If you believe that you need immediate inpatient care, go to the nearest emergency room (ER) for an evaluation. The ER team will then contact us to determine the next steps based on your clinical needs and your coverage.

Or, if you are unsure about what level of care would be best for you:

1. Talk to your PCP or your outpatient therapist

Have a discussion with your current providers if you believe you may need inpatient treatment. You’ll need to have an evaluation by a BH specialist who can confirm that inpatient care is the best level of care for you.

2. Call us

Call member services at 888-257-1985 (TTY: 711) if you need help getting an evaluation or finding an in-network facility that provides the services you need. We are available Monday to Friday, from 8 a.m. to 5 p.m.