Frequently Asked Questions

Do I need to obtain an initial authorization to see a Tufts Health Freedom Plan behavioral health provider?

If you have an EPO plan, either you or your behavioral health provider need to notify Tufts Health Freedom Plan within 30 days of your first appointment. It is, however, your behavioral health provider’s responsibility to verify that notification has occurred. You can call our Behavioral Health Services Department at 800.547.5186 and choose one of the two options:

1. Follow the prompts to access our Behavioral Health Interactive Voice Response system (IVR).

You will need to provide:

  • Your Tufts Health Freedom Plan ID number, including the suffix
  • Your date of birth
  • Your Behavioral Health provider's 10-digit National Provider Identifier (NPI)
  • The start date of your 1st appointment

OR

2. Follow the prompts to speak directly with a service coordinator who will assist you.

You will receive a confirmation number that begins with the letter "V" that you should bring to your 1st appointment.

Outpatient treatment notification is not necessary for PPO members.

Can initial requests for treatment be backdated?

Initial notifications of treatment can be backdated for up to thirty days after the initial date of service.

How long is a request for behavioral health treatment in effect?

Reference numbers are valid for 12 months from the start date and are subject to medical necessity and your benefit limits.

How do I receive additional visits after my initial notification?

It is the responsibility of your behavioral health provider to notify Tufts Health Freedom Plan when additional visits are needed.

What about additional sessions for medication management?

A psychiatrist or psychiatric clinical nurse specialist who provides medication management needs to notify Tufts Health Freedom Plan of an initial medication management evaluation. Additional medication management visits (15-20 minutes in length with no therapy) do not require notification and are unlimited throughout the year. You are responsible for your office visit co-pay for these visits.

When does my yearly benefit renew?

Most policies renew on January 1. However, policies vary. You can verify your annual effective dates with your employer, or by logging in to the Member Resource Center, checking your benefit document, or calling our Behavioral Health Services Department at 800.547.5186.

Who should keep track of a Tufts Health Freedom Plan member's benefit?

You and your Behavioral Health providers share the responsibility to monitor the number of visits you have used. To track visits accurately, you will need to login to the Member Resource Center. We recommend that you let your Tufts Health Freedom Plan Behavioral Health providers know if you are in treatment with other providers. Please note that authorizations do not override your benefit limit. The number of visits reimbursed cannot be greater than the number of sessions covered in your yearly benefit.

How do I know how many visits I have for the year?

The number of visits available to Tufts Health Freedom Plan members varies. Co-payments may also vary. Please login to the Member Resource Center, check your benefit document for details or call our Behavioral Health Services Department at 800.547.5186.

Do I have separate benefits for behavioral health and alcohol/substance abuse services?

Behavioral health and alcohol/substance abuse benefits usually are separate benefits. The primary diagnosis submitted by your provider determines which benefit is used. Please check your benefit document for details or call our Behavioral Health Services Department at 800.547.5186.

How do I obtain authorization for psychological or neuropsychological testing?

Prior authorization is required for psychological and neuropsychological testing. Providers are required to submit a request form prior to an initial testing evaluation. Your provider can obtain the appropriate prior authorization request form.

Once all information is received, a psychologist or medical director will review it and make a decision, usually within two business days. The provider who requested the testing will be notified by telephone and you will be notified of the decision in writing.

Please note that testing for educational purposes or learning disabilities is typically not covered. Tufts Health Freedom Plan members should have a comprehensive evaluation with a psychiatrist or neurologist before requesting psychological testing.

What is Mental Health Parity?

Under state and federal laws, benefits for mental health services and substance use disorder services must be comparable to benefits for medical/surgical services. This means that copayments, coinsurance and deductibles for mental health and substance use disorder services must be at the same level as those for medical/surgical services. Also, Tufts Health Freedom Plan’s review and authorization of mental health and substance use disorder services must be handled in a way that is comparable to the review and authorization of medical/surgical services.

Treatment for members who are covered under any of the mental health parity laws may still need to meet medical necessity guidelines. Therefore, under parity some plans may still require authorization.

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