Welcome to the Tufts Health Plan treatment cost estimator web tool (the “Site”), powered by HealthSparq One, owned and controlled by HealthSparq, Inc. and affiliates (“HealthSparq”). The Site provides a portal to an online service (the "Service") sponsored by Tufts Associated Health Maintenance Organization, Inc. and affiliates (hereinafter "Tufts Health Plan") for use by Tufts Health Plan members. Tufts Health Plan and HealthSparq are collectively referred to herein as "we," "our, and/or "us." Before you begin, please take a minute to ensure that you understand the terms and conditions of our relationship by reading this important information, which includes certain limitation of liability and indemnification provisions applicable to your use of the Service.
1. IMPORTANT DISCLAIMERS AND LIMITATIONS
Reliance on Price Estimates and Other Information: Reliance on information provided on this Site is solely at your own risk except as may be otherwise provided by law. You should exercise independent judgment before applying any information provided on this Site to your own financial and health management needs, or otherwise relying on other information. As noted below, the cost estimates included in this Service are generated by HealthSparq and Tufts Health Plan. The cost estimates provided in this Service are estimates only and are not a guarantee of payment or benefits.The estimates are based on Tufts Health Plan’s claims averages for the selected services with in-network providers or, where such data is not sufficiently available, national claims averages for the selected services (estimate will note “US Average” in this case). Your actual cost may be higher or lower than the estimate for various reasons.
The results displayed are estimated costs based on information available to Tufts Health Plan and HealthSparq at the time the request is made, including any facility fee, copayment, deductible, coinsurance of other cost-sharing requirements for any medically necessary covered services. The actual amount you will be responsible to pay may vary due to unforeseen services that arise out of your proposed admission, procedure or service. Actual charges and out-of-pocket costs may also be different if the admission, procedure, or service is different than the type quoted, your coverage changes, the provider bills the services differently, or if there are unforeseen services that were not included in the estimate because they were not apparent based on the information requested. National averages for some services may be higher than actual costs for such services with Tufts Health Plan network providers.
All cost estimates are calculated based only on your selection of providers who participate with your plan (i.e., in-network providers) and are specific to the service, provider, and place of service searched. When care is provided by an in-network provider, you are responsible for any applicable cost share as stated in the terms of your benefit document. If you choose to see an out-of-network provider (a provider who is not in the network applicable to your plan), depending on the specific terms of your plan, your services may not be covered and/or you may be financially responsible for any charges, including charges above the approved rates, if any. Emergency care is covered at the authorized level of benefits, regardless of whether you see an in-network or out-of-network provider.
The cost estimates displayed do not constitute authorization for any admission, procedure or treatment; such authorization must be obtained separately if required. Your plan out-of-pocket cost is valid as of the date listed with the estimate. Your plan eligibility is based on information made available from various sources, such as an employer group or state exchange, and our systems may not reflect your actual status. Deductible and out-of-pocket maximum status may change based on in-process claims. For more information, please review the “Estimates are not Authorizations/Not Responsible for Coverage Determinations” section below.
HealthSparq and Tufts Health Plan cannot guarantee that all information included for health care providers and facilities is current and up to date, and some of this information is subject to change without notice. Before making any health care purchasing decision, you should check on any pieces of information of importance to you (e.g., that your doctor or facility is still in the Tufts Health Plan provider network, or accepting new patients, as well as the provider's quality metrics). If you have any questions about a cost estimate, and/or benefit, referral, or authorizations, please call a member specialist at the number on your membership card.
Estimates are not Authorizations/Not Responsible for Coverage Determinations: This Service will provide assistance to help you understand your health care coverage and payment options. Statements, interpretations, advice or opinions by this Service regarding health care coverage and/or payment options are solely provided to assist you with your decision making and are based on review of information available regarding your plan (which may or may not be complete and/or current). The accompanying information available on this Site should not be construed as representing your health plans or employer's medical policies or clinical programs. The ultimate decision on whether a procedure is covered, and to what extent coverage may be provided, rests solely with your health plan and not with HealthSparq.
Nothing on this site guarantees eligibility, coverage, or payment, or determines or guarantees the benefits, limitations or exclusions of your coverage. Use of this Service in no way increases or decreases the benefits under your health plans or employer's benefit plan. For a complete description of the details of your coverage, please refer to your coverage documents. If there is any conflict or discrepancy between the content on this Site and your coverage documents, your coverage documents will control.
All claims will be processed when received according to your specific plan provisions. You will be responsible for the cost of procedures or services not covered by your plan. Pre-authorizations or referrals are required for certain benefit plans and certain healthcare providers. Refer to your benefit plan to determine whether these requirements apply to you. Please note that the cost estimates displayed through this Service do not constitute authorization for any admission, procedure or treatment. Authorization must be obtained separately if required.
Not Professional Advice: While cost and quality information are emphasized within this tool, it is important to note that many other factors impact the selection of providers. These may include established provider relationships, network considerations, primary care referrals, and/or benefit plan design. This Service seeks to provide members with additional information to enable them to make an informed decision about their healthcare. It is broad in scope and intended only to assist you in the organization of and decision-making relating to your health care coverage and payment options. It is not intended to provide legal, medical, healthcare coverage, tax or financial advice. HealthSparq is not itself, or an agent of, a health care provider, health plan, broker or tax or financial advisor.
Your personal situation is unique, and any information and advice obtained through the Service may not be appropriate for your situation. Accordingly, before making any final decisions or implementing any financial or health care strategy, you should consider obtaining additional information and advice from your health care provider, health plan, advisor, broker or others who are fully aware of your individual circumstances.
The HealthSparq cost estimator tool groups together services that are often delivered together to address a particular medical problem. The inclusion of particular services in an estimate is not medical advice that any particular service is the right treatment for you, or that you should not get a service that is not included in an estimate. All of those matters are things that you should decide, in consultation with your health care professionals.
The health-related information and resources in the Service is made available to you solely for informational purposes and is intended to supplement, not substitute for, the expertise and judgment of your healthcare professional. It does not constitute medical advice and is not a substitute for professional medical care. Nothing on this site is intended to be used for medical diagnosis or treatment, including information regarding which drugs or treatment may be appropriate for you. None of the information on this Site represents or warrants that any particular drug or treatment is safe, appropriate or effective for you. Always seek the advice of your health care provider before beginning any new treatment or if you have any questions regarding a medical condition. If you are ill or need immediate medical care, please contact your health care provider or, in an emergency, call 911 or go to the nearest medical facility.
Educational Resources: This Service may make available self-care informational services which provide general medical and health information. These communications and resources are not comprehensive medical texts and do not include all the potential information regarding the subject matter. These communications and resources are for general educational and informational purposes only, and should not be relied upon as a substitute for patient-specific medical diagnosis and treatment or construed, directly or indirectly, as the practice of medicine or dispensing of medical services by HealthSparq or Tufts Health Plan. Such information is not a substitute for seeing an appropriate healthcare professional for medical treatment. We make no warranty as to the content of these materials or the information contained therein.
2. RIGHTS YOU GRANT TO US
With the Service, HealthSparq may be accessing information about you or your minor dependents provided by Tufts Health Plan (“Account Information”). HealthSparq does not review the Account Information for any purpose, including but not limited to accuracy, legality or non-infringement. HealthSparq is not responsible for the products and services offered by Tufts Health Plan other than the Service discussed herein.
We cannot always foresee or anticipate technical or other difficulties that may result in failure to obtain data or loss of data, personalization settings or other service interruptions. We cannot assume responsibility for the timeliness, accuracy, deletion, non-delivery or failure to store any user data, communications or personalization settings. For example, when displayed through the Service, Account Information is only as fresh as the time shown, which reflects when the information is obtained from such sites. By submitting information to us through the Service, you are allowing us to use that information solely for the purpose of providing the Service. We may use and store the content, but only to provide the Service. By submitting this content to us, you represent that you are entitled to submit it to us for use for this purpose, without any obligation by us to pay any fees or other limitations.
3. LEGAL NOTICES
Additional Disclaimers: YOU UNDERSTAND AND AGREE THAT: YOUR USE OF THE SERVICE AND THE SITE AND ALL INFORMATION, PRODUCTS AND OTHER CONTENT (INCLUDING THAT OF THIRD PARTIES) INCLUDED IN OR ACCESSIBLE FROM THE SERVICE IS AT YOUR SOLE RISK. THE SERVICE IS EITHER A BETA (IN DEVELOPMENT) SERVICE OR IS NEWLY IN PRODUCTION AND IS PROVIDED ON AN "AS IS" AND "AS AVAILABLE" BASIS. TUFTS HEALTH PLAN, AND ITS AFFILIATES, DIRECTORS, OFFICERS, EMPLOYEES OR OTHER REPRESENTATIVES (COLLECTIVELY, "AFFILIATES") EXPRESSLY DISCLAIM ALL WARRANTIES OF ANY KIND AS TO THE SERVICE AND ALL INFORMATION, PRODUCTS AND OTHER CONTENT (INCLUDING THAT OF THIRD PARTIES) INCLUDED IN OR ACCESSIBLE FROM THE SERVICE OR THE SITE, WHETHER EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING, TUFTS HEALTH PLAN IS NOT RESPONSIBLE FOR THE ACCURACY OR RELIABILITY OF ANY REVIEWS, RATINGS OR DATA FROM ANY THIRD PARTY. WHILE HEALTHSPARQ TAKES STRINGENT PRECAUTIONS TO PROTECT YOUR DATA AND COMPLY WITH PRIVACY RULES AS SET FORTH IN THE HEALTHSPARQ COUPP, WHICH CAN BE FOUND HERE. TUFTS HEALTH PLAN CANNOT FULLY GUARANTEE THE SECURITY OF ANY INFORMATION YOU MAY PROVIDE OR ANY INTERRUPTIONS IN THE AVAILABILITY OF ANY SERVICE. COMPLIANCE WITH THE HEALTHSPARQ COUPP DOES NOT ENSURE, AND TUFTS HEALTH PLAN AND ITS AFFILIATES MAKE NO WARRANTY, THAT (i) THE SERVICE WILL MEET YOUR REQUIREMENTS, (ii) THE SERVICE WILL BE UNINTERRUPTED, TIMELY, SECURE, OR ERROR-FREE, (iii) THE RESULTS THAT MAY BE OBTAINED FROM THE USE OF THE SERVICE WILL BE ACCURATE OR RELIABLE, (iv) THE QUALITY OF ANY INFORMATION, OBTAINED BY YOU THROUGH THE SERVICE WILL MEET YOUR EXPECTATIONS, (v) THE ACCURACY OR RELIABILITY OF ANY THIRD PARTY RATINGS OR INFORMATION, AND (vi) ANY ERRORS IN THE TECHNOLOGY WILL BE CORRECTED. NO ADVICE OR INFORMATION, WHETHER ORAL OR WRITTEN, OBTAINED BY YOU FROM OR THROUGH OR FROM THE SERVICE WILL CREATE ANY WARRANTY NOT EXPRESSLY STATED IN THESE TERMS.
Limitation of Liability: IN NO EVENT SHALL TUFTS HEALTH PLAN, HEALTHSPARQ, NOR ANY OF THEIR AFFILIATES, BE LIABLE FOR ANY DIRECT, INDIRECT, SPECIAL, PUNITIVE, INCIDENTAL, EXEMPLARY, OR CONSEQUENTIAL DAMAGES, OR ANY DAMAGES WHATSOEVER RESULTING FROM ANY LOSS OF USE, LOSS OF PROFITS, LITIGATION, OR ANY OTHER PECUNIARY LOSS, WHETHER BASED ON BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE), PRODUCT LIABILITY, OR OTHERWISE, ARISING OUT OF OR IN ANY WAY CONNECTED WITH THIS SITE OR THE PROVISION OF OR FAILURE TO MAKE AVAILABLE ANY SUCH PRODUCTS, GOODS, OR SERVICES, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. FURTHER, IN NO EVENT SHALL TUFTS HEALTH PLAN BE LIABLE FOR ANY DAMAGES CAUSED BY YOUR OR ANY THIRD PARTY'S ACTS OR OMISSIONS.
When using the Service, information will be transmitted over a medium, which may be beyond the control and jurisdiction of Tufts Health Plan, HealthSparq, their customers and/or vendors. Accordingly, Tufts Health Plan and HealthSparq assume no liability for or relating to the delay, failure, interruption or corruption of any data or other information transmitted in connection with use of the Service.
Some jurisdictions do not allow the exclusion of certain warranties or the limitation or exclusion of liability for incidental or consequential damages. Accordingly, the above disclaimers and limitations may not apply to you if you reside in such a jurisdiction. You may also have other legal rights that vary from state to state.
4. INTELLECTUAL PROPERTY
Copyrights Trademarks and Patents: All of the: (a) content included on the Site, including text, art, graphics, logos, button icons, images, pictures, audio clips and software ("Content"); (b) trademarks, trade names, logos, brand names and service marks ("Marks") of Tufts Health Plan and/or HealthSparq, whether registered or unregistered; and (c) patents and patent applications ("Patent Rights") of HealthSparq, are the property of Tufts Health Plan and/or HealthSparq, their members, partners or content providers, and are protected by U.S. and international copyright, trademark or patent laws, as applicable. Except as granted in the limited license below, any use of: (i) Content, including modification, transmission, presentation, distribution or republication; (ii) Marks; or (iii) Patent Rights is prohibited without the prior written consent of Tufts Health Plan and/or HealthSparq (or if a Mark is owned by a third party, the prior written consent of such third party).
Third Party Licenses: You agree that you will not upload or transmit any communications or content of any type that infringe or violate any rights of any party.
Data: Tufts Health Plan and HealthSparq welcome your feedback as a user of the Service, and may request your feedback regarding the Service or providers referenced in the Service through surveys, bulletin boards, emails or other means. Any feedback you provide will become the confidential and proprietary information of Tufts Health Plan and/or HealthSparq, and you agree that Tufts Health Plan and/or HealthSparq may use in any manner and without limitation all comments, suggestions, complaints, reviews and other feedback you provide relating to the Service. Tufts Health Plan and/or HealthSparq shall have a worldwide, royalty-free, non-exclusive, perpetual, and irrevocable right to use feedback for any purpose, including but not limited to, incorporation of such feedback into the Service or other Tufts Health Plan or HealthSparq software or services.
5. RESTRICTIONS/PASSWORDS AND TERMINATION
Restrictions on Use: You agree that you will not: (i) use the Service in order to invade the privacy of, obtain the identity of, or obtain any personal information about any other user of the Service; (ii) modify, erase or damage any information contained on the computer of any user connected to the Service; (iii) reverse engineer any portion of the Site or Service, or (iv) use the Site or Materials in any manner that is inconsistent with the limited license granted herein. Additionally, you agree not to post or transmit: (a) information under a false name; or (b) any information which (i) is libelous, defamatory, obscene, fraudulent, false or contrary to the ownership or intellectual property rights of any other person, or (ii) contains any virus, worm, Trojan horse or other code which is contaminating or destructive to the files or programs of Tufts Health Plan, HealthSparq or any of their users. Tufts Health Plan and HealthSparq reserve the right to delete any information provided by you that we deem in our sole discretion fraudulent, abusive, defamatory, obscene or in violation of a copyright, trademark or other intellectual property or ownership right of any other person.
Passwords: As a user of the Service, you will access the Site through Tufts Health Plan's password protected member portal. You hereby agree that you will keep your password protected and not share it with others; and promptly inform Tufts Health Plan of any need to deactivate a password. To do so, you may contact a Tufts Health Plan member specialist at the number on your membership card.
Termination: Tufts Health Plan and HealthSparq reserve the right to refuse access to the Site and to terminate your use of the Site if we believe that your conduct violates any applicable law or is harmful to the interests of us, our members, partners or suppliers, or other users, or for any other reason in our sole discretion, with or without cause.
6. GENERAL LEGAL PROVISIONS
Third Party Links: The Service may include links to third party websites, which may include opinions, information or recommendations of various third parties. In providing such links, Tufts Health Plan and HealthSparq do not represent to you that we or any of our customers has investigated the content of such third-party websites. Tufts Health Plan and HealthSparq do not warrant or guarantee the accuracy of any content included on third party websites nor do we endorse, credential or accredit any opinions, recommendations or information included on such third-party websites. Your use of third-party websites is subject to the terms and conditions of use for such websites.
International Laws: HealthSparq is based in the State of Oregon in the United States of America. Tufts Health Plan is based in the Commonwealth of Massachusetts in the United States of America. Tufts Health Plan and HealthSparq make no claims that the Content of the Service is appropriate or may be downloaded outside of the United States. Access to the Content may not be legal by certain persons or in certain countries. If you access the Service from outside the United States, you do so at your own risk and are responsible for compliance with the laws of your jurisdiction.
Third Party Rights: The indemnification provisions set forth above and the provisions under Section 2 Legal Notices and Disclaimers are for the benefit of Tufts Health Plan, HealthSparq and their Affiliates, customers, and third party providers of data, software and content. Each of these individuals or entities shall have the right to assert and enforce those provisions directly against you on its own behalf.
Last updated December 18, 2017.