Tufts Health Plan

One of the barriers to mental health is confusion navigating the process of copays, deductibles, and reimbursement. We’re setting out to demystify the insurance process by answering your questions about using Tufts Health Plan insurance for behavioral health!

 
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What does Tufts Health Plan Cover for Therapy?

Does Tufts Health Plan pay for therapy?

Yes, insurance through Tufts Health Plan does pay for mental health and substance use treatment. Coverage varies from plan to plan, so to find out the cost to you for therapy, refer to the specific benefits and coverage details outlined in your plan documents.

Does Tufts Health Plan cover online therapy?

Some providers that accept Tufts Health Plan insurance do offer online therapy, which can be a helpful alternative if you’re having logistical scheduling in-person appointments or if you’d like to manage your medication without visiting your therapist’s office. To find out whether your plan covers online therapy, you can contact member services or refer to your plan documents.

What kind of coverage does Tufts Health Plan offer for mental health?

Tufts Health Plan covers a variety of mental health treatments and options, including inpatient services when medically necessary. However, your specific coverage will vary according to your plan. You can learn more about mental health treatment with Tufts Health Plan here.

How much does Tufts Health Plan reimburse for therapy?

Reimbursement for therapy varies between plans. To find out how much you can be reimbursed for your therapy sessions, you can refer to your plan documents or contact member services. You can find member services phone numbers here or on your insurance card.

How much are therapy sessions under a Tufts Health Plan plan?

Cost per session may depend on the specifics of your plan, and the provider rate. You can review your copayment amounts by logging in to your secure member portal, checking your benefit document for details, or calling member services. You can find member services phone numbers here or on your insurance card.

What is my copay for therapy with Tufts Health Plan?

Most Tufts Health Plan insurance  plans have a copay, which is a preset amount you pay for for covered health services at the time you receive care. However, the amount of your copay depends on the details of your specific plan. Although you will not pay a copay when you use a doctor or facility that is out-of-network, you are responsible for paying coinsurance, which is a percentage of the total bill. Coinsurance is usually much more expensive than an in-network copay. You can review your copayment amounts by logging in to your secure member portal, checking your benefit document for details, or calling member services. You can find member services phone numbers here or on your insurance card.

What is my deductible for therapy with Tufts Health Plan?

Deductibles also depend on the specific insurance you have through Tufts Health Plan. You usually determine your annual deductible when you purchase insurance. To find out what your deductible is, you can check your plan documents, log into your secure member portal, or contact member services for more information. Member services phone numbers are available here or on your insurance card.

What happens if I don’t use a Tufts Health Plan therapist?

If you don’t use a Tufts Health Plan therapist, you’ll be responsible for navigating out-of-network benefits. This process can be confusing, so it’s best to call member services directly to get more information. Member services phone numbers are available here or on your insurance card.

When you call your insurance company, be sure to ask:

  • What is my annual deductible?

  • Do I have an additional out-of-network deductible?

  • What is my coinsurance for outpatient mental health?

  • Do I need a referral from a primary care physician or an in-network therapist to see an out-of-network therapist?

  • How do I submit out-of-network claims for reimbursement?

Claims and Reimbursements for Tufts Health Plan

How long do you have to submit a health insurance claim with Tufts Health Plan?

You must submit your claims within 90 days of the date of service. If Tufts Health Plan receives a claim that is not within the 90-day period, the claim will be denied.

How do I complete Tufts Health Plan claims for therapy?

Electronic submission is preferred for Tufts Health Plan claims, but you can also submit a paper claim by mail. Full instructions for submitting claims are available here.

What is the Tufts Health Plan claims address?

Tufts Health Plan has multiple claims addresses for different plans. All of the addresses are available here; be sure to choose the one that matches the name of your plan.

What is the number for Tufts Health Plan behavioral health?  

If you have an employer-sponsored insurance plan, you can contact Tufts Health Plan at 800-208-9565. For other plans, you can contact 888-257-1985.

How should I get therapy if I don’t have insurance?  

If you want to find a therapist but don’t have insurance, you can visit Zencare’s search page to look for therapists who have sliding scale fee options or who offer sessions within your price range.

How can I find Tufts Health Plan therapists?

If you live in Rhode Island or Boston, you can find a therapy provider who accepts Tufts Health Plan insurance on Zencare. Select Tufts Health Plan as your insurance company under "Payment Options" to view therapists who are in-network.

Visit therapists’ profiles to watch an introductory video, check up-to-date availability, and book a free initial call to find the right therapist for you.

Live outside those areas? You can go to the Tufts online directory and either log into your account or search for providers by plan name. In either case, you can select “behavioral health” or “mental health” as your provider type and search for therapists in your area. Note, however, that information is often out of date. Reach out to multiple therapists, and don’t be discouraged!