Complaints, Grievances and Appeals

Tufts Health Public Plans is committed to ensuring quality care and services for its providers and members

All Tufts Health Public Plans providers and members have a right to:

• Voice complaints or grievances about Tufts Health Public Plans, the care provided, and those providing care
• File an appeal regarding any adverse decision made by Tufts Health Public Plans, including service coverage determination as well as administrative denials
• File an appeal as a member, or as a provider acting on behalf of a member, with the MassHealth Board of Hearings after an adverse action resulting from a final determination (final level of internal Tufts Health Public Plans review) related to a medical necessity or service coverage determination

Complaints

Any member or authorized representative may file a complaint by calling the appropriate Tufts Health Public Plans member services team. We will address all complaints we receive. A provider may file a grievance as the member’s authorized representative.

Massachusetts Member Services phone number: 888.257.1985.
Please call Monday through Friday, from 8 a.m. to 5 p.m.

Rhode Island Member Services phone number: 866.738.4116.
Please call Monday through Friday, from 8 a.m. to 6 p.m.

Grievances

A member or authorized representative may file a grievance. In Massachusetts, we acknowledge a grievance within one business day. In Rhode Island, we acknowledge a grievance within five business days. We acknowledge all grievances and will address the grievance in writing within 30 calendar days of receipt.

You may file a grievance by phone, fax or mail:

To file a grievance for a Tufts Health Public Plans member in Massachusetts, you may do the following:

• Call Member Services at 888.257.1985
• Fax your grievance to 857.304.6342
• Fax your grievance to 617.972.9509 (for Tufts Health Direct members)
• Or write to:
  Tufts Health Plan
  Attn: Grievance Coordinator
  P.O. Box 9193
  Watertown, MA 02471-9194

To file a grievance for a Tufts Health Public Plans member in Rhode Island, you may do the following:

• Call Member Services at 866.738.4116
• Fax your grievance to 857.304.6406
• Or write to:
  Tufts Health Plan
  Attn: Grievance Coordinator
  P.O. Box 9193
  Watertown, MA 02471-9194