Tufts Health Plan Coverage for Addiction Treatment  

Using Tufts Health Plan Coverage to pay for addiction treatment: There are drug and alcohol treatment centers that accept Tufts Healthcare insurance. Depending on your plan and the treatment provider that you choose will determine what Tufts will cover. It is best to know exactly what your coverage will pay before deciding which program to choose for your recovery. Some rehabs we work with are in-network with many providers including Tufts, which means that your treatment may be fully covered or partially covered depending on your insurance plan. You can also call us to find out if there are any drug rehab centers nearby that take Tufts Health Plan. Most insurance plans will cover drug and alcohol rehab treatment programs. If you would like to find out more about drug rehab programs near you, give us a call and we can get your insurance verified today.

1-800-513-5423

What you will learn:

• About Tufts Health Plan
• Does Tufts insurance pay for substance abuse treatment?
• What are the types of treatment that Tufts insurance may pay for?
• How much will you have to pay in out-of-pocket expenses?
• What to do if your provider is out-of-network?
• Benefits of using your Tufts insurance to pay for addiction treatment 
• Why call us?

About Tufts Health Plan

Tufts Health Plan is a non-profit insurance group that has been in business since 1979. This insurance group is a nationally recognized organization for its commitment to providing innovative and high-quality healthcare coverage. Tufts offers traditional HMO, and PPO plans to national, tiered, and network plans. They also have a national care link product that works in collaboration with Cigna to provide coverage to multi-state employees. Their network has about 110 hospitals and 51,000+ healthcare providers.

Tufts headquarters is in Massachusetts, they also serve Connecticut and Rhode Island. Tufts is one of the few health plans in Massachusetts to participate in the commercial, Medicaid, and Medicare markets, offering coverage across the lifespan regardless of age or circumstance.

Does Tufts insurance pay for substance abuse treatment?

Tufts insurance will pay for some or all of your substance abuse treatment depending on the plan you have chosen, and whether your preferred provider is in-network or out-of-network. This will determine what your financial responsibilities are. Tufts insurance covers addiction treatment but the amount of coverage can vary from center to center and the plan you have chosen.

What are the types of treatment that Tufts insurance may pay for?

The programs for alcohol and substance misuse that Tufts insurance may cover are:

• Residential Inpatient treatment programs consist of you staying at a center for a set amount of time while undergoing treatment for alcohol or drug addiction.

• Outpatient therapy programs usually meet at least once a week for therapy either on a one-on-one basis or in a group setting.

• Medication-assisted treatment plans offer several different medications for those needing help recovering from opioids, alcohol, or benzodiazepines. Typically, this type of treatment also has counseling, therapy, and support while enrolled in the program.

• Intensive outpatient treatment programs usually consist of therapy and activities several times a week to give you a solid foundation to start building on your recovery. These types of programs work best if you have a stable home environment or have a sober living house to give you support while undergoing treatment.

• Detox is a medication-assisted program that helps those who cannot withdraw from medications, drugs, or alcohol without medical complications. Detox programs are monitored by medical professionals to ensure a safe withdrawal from most drugs and alcohol.

How much will you have to pay in out-of-pocket expenses?

Coverage amounts for drug and alcohol addictions are dependent on your individual policy, co-insurance, deductible, and copays. Many people have a set deductible for both medical and mental health services. This is a set amount that you must pay before your Tufts insurance plan will start covering your rehab stay. Once your insurance plan starts paying after the deductible has been met, they will typically cover a set amount, depending on your plan. You might need to pay the remaining amount if you have reached your coverage limits.

• Co-insurance is a percentage of a covered service or procedure that you are responsible for. Example: If you have a "30% coinsurance" policy, it means that, when you have a medical bill, you are responsible for 30% of it. You may have to meet a deductible before you make the co-insurance payment depending on your policy.

• Deductible is the amount of money you must pay before Tufts will cover any expenses. Example: if you have a $5000 deductible you will have to pay that before they will cover the rest of your rehab stay.

• Copay is a set amount that you will pay for a service or procedure before you have met your deductible. You may have to make copayments even after you have met your deductible depending on your policy.

What to do if your provider is out-of-network?

Tufts Insurance Group has a network of providers that they have contracted with to provide services for their policyholders. This lowers the out-of-pocket expenses you need to come up with to receive benefits. This is called "in-network".

Out-of-network providers have no such agreement, and you may need to discuss upfront costs with the insurance provider before committing to treatment. Many out-of-network providers can set up a payment plan or refer you to a third-party lender that offers loans for substance abuse treatment programs. The center that you have chosen may be able to lower the cost of treatment at their center by directly working with Tufts to negotiate an in-network rate.

Benefits of using your Tufts insurance to pay for addiction treatment 

Having insurance can help lower the out-of-pocket costs that you have to pay at a private drug rehab center. You have paid the premiums and have benefits that you should use to get the help you need. Not using your insurance will only make it so you must come up with the total costs for treatment at your center of choice. Think of it like car insurance, if you get in a wreck, you call your insurance provider, pay the deductible, and get your car fixed. It is almost the same as using your health insurance, but you may still need to come up with co-insurance, deductibles, and copayments. Regardless of that, the amount you pay will still be a fraction of the actual costs of the service.

Why call us?

Our addiction specialists have working relationships with centers that accept Tufts insurance. Depending on your policy and agreement with the insurance provider your rehab stay may be free. We can help you understand your insurance policy and help you see if your specific plan is in-network with one of the facilities we work with. We are here to help you navigate and understand what exactly your insurance plan will pay for. You don’t need to get frustrated trying to understand your coverage. We will handle all the insurance companies’ questions and specifics when trying to enter a drug rehab center. Our counselors have over 20 years of experience in the field of addiction and have working relationships with in-network rehab center programs that accept Tufts insurance. Your insurance provider will not be contacted or notified unless you decide to enter treatment and use your insurance.

 If you would like to find out more about drug rehab programs near you, give us a call and we can get your insurance verified today. 

1-800-513-5423

Sources


About Tufts Health Plan 

The Mental Health Parity and Addiction Equity Act (MHPAEA) 

Tufts Member Substance Use Support  

Medications, Counseling, and Related Conditions

Mental Health Substance Abuse Coverage

Erik Epp – Content Author