Understanding Your Behavioral Health Benefits

Seeking Help for Behavioral Health? We're With You.

If you or a family member is ready to seek help for behavioral health, we’re here to make the process as smooth as possible. Because when you get the right care, you’ll feel so much better. You can call our Behavioral Health Services Department at 800.547.5186 for more information.

Get Access to the Care You Need

Accessing Outpatient Behavioral Health Services

1. Check the plan name on your ID Card.

If your ID card says “EPO” in the plan name, then you need to see in-network providers for counseling services. You do not need a referral from your Primary Care Provider (PCP)*

If your ID card says “PPO” in the plan name, you can choose to see in-network or out-of-network providers. Choosing an out-of-network provider will provide maximum flexibility, but with higher out-of-pocket costs.

2. Choose a provider.

Log in to thfp.com/memberlogin and select “Doctor Search.” Choose “Doctors by Specialty” and then enter the type of care you are seeking, such as “adult mental health”, “child mental health” “substance use disorder”, etc.

If your PCP gives you the name of a specific provider, be sure to check the online directory to confirm that he or she is in-network.

You can also call our Behavioral Health Department at 800.547.5186. We’ll be glad to provide a list of providers and their phone numbers based on your needs. You may need to call multiple providers to find one who has openings that fit your schedule.

3. Set up an appointment.

Call the provider and set up your appointment. Your provider is responsible for notifying Tufts Health Freedom Plan of your first appointment.

For added convenience, if your plan allows, you may want to consider using our telehealth service powered by Teladoc®. It gives you 24/7 access to an in-network counselor by phone, web or mobile app! Find out more at teladoc.com/tuftshealthfreedomplan.

What if you're a new member with an existing Outpatient Provider?

1. Look for your provider in our network.

To find a provider, log in to thfp.com/memberlogin and select “Doctor Search”, select ”Doctor by name” and enter the name of your current provider.

2. Don’t see your provider on the list?

If your provider is interested in joining our network, they can contact our allied health department at 617.972.9495, or review the credentialing and contracting application process online.

Or we can help find a new in-network provider who will work best for you.

Accessing Inpatient Behavioral Health or Substance Use Disorder Services

1. Call us at 800.547.5186

You or a designated representative can call us to learn what inpatient behavioral health facility is covered under your benefits. EPO members need to seek care at an in network facility.

PPO members can seek inpatient care at any in network facility and be covered at the in network level of benefits. PPO members can also seek care at an out of network facility. PPO members have the option of receiving medically necessary services outside of the Tufts Health Plan network of contracted facilities. However, these members will be covered at the out of network level of benefits, which means they will be responsible for paying an out of network deductible and coinsurance for any medically necessary covered services they receive. An out of network facility may result in higher out of pocket costs.

2. Search for a behavioral health facility

Review complete listings of participating behavioral health facilities.

3. Go to the Emergency Room

If you feel you need immediate inpatient care, you can go to the nearest emergency room (ER) for an evaluation. The ER team will then contact Tufts Health Freedom Plan to determine the next steps based on your clinical needs and your coverage.

Be aware of the types of care.

If your plan has out-of-network benefits, it may seem appealing to attend an out-of-state facility where your troubles seem far away.

However, be careful about out-of-state treatment centers — not all are legitimate. Some are recruiting patients only to offer inadequate care and leave people stranded. The Massachusetts Attorney General warned of out-of-state addiction treatment scams in 2017.

If you need help determining what type of care will work best for you, contact our behavioral health department at 800.547.5186. We’re with you on the path to better health.

Learn more about treatment for alcohol and substance use disorder.

 

Common Behavioral Health Benefits Questions

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