Information for Specific Insurers
Tufts Health Plan
At each visit to the OCC you are required to make the co-payment
listed on your insurance card. It is important for you to
confirm coverage for the behavioral health services, along
with all medical services from your insurance. For mental
health services, please call the 1-800 mental health phone
number on your Tufts insurance card. Ask for authorization
for outpatient psychiatry at Tufts-New England Medical Center.
You will be given an authorization number good for from 1
to 12 visits. Please bring this authorization with you to
your initial evaluation. For medical visits, Tufts will only
allow patients to see providers within their “designated”
network. Your Primary Care Physician (PCP) must provide you
with a referral for your medical visits. If you do not obtain
a valid referral prior to your medical visit, your appointment
may be re-scheduled in order to allow you additional time
to obtain a referral to the OCC.
Blue Cross
You are required to make the co-payment listed on your insurance
card at each visit to the OCC.
For mental health services, please read the following statement:
Blue Cross HMO are subcontracted to Magellan Behavioral Health
and not paid directly by Blue Cross. Tufts-NEMC does not have
a contract with Magellan Behavioral Health for outpatient
mental health services. Blue Cross rarely allows “out
of network” authorizations. Each behavioral health appointment
will require payment in full at the time of service. (See
Fee Schedule.) You will receive a receipt from Tufts-NEMC
upon payment, which you can submit to Blue Cross to determine
if they will pay you directly.
Blue Cross PPO plans
For all visits to the OCC, please contact the telephone number
listed on the back of your insurance card to ensure that Blue
Cross will cover this service at Tufts-NEMC. You must confirm
approval from a Blue Cross Representative prior to the date
of your appointment at Tufts-NEMC. Additionally, you will
be required to sign a waiver of liability at the time of service.
In the event that Blue Cross does not pay for the service,
you will be responsible for payment in full.
Harvard Pilgrim Health Care
You are required to make the co-payment listed on your insurance
card at each visit to the OCC. For mental health services
in the OCC please read the following statement: Harvard Pilgrim
Health Care subcontracts their mental health services to Value
Options Behavioral Health. Tufts-NEMC does not have a contract
with Value Options; therefore we can not bill for the mental
health services. Value Options rarely allows “out of
network” authorizations. Each behavioral health appointment
will require payment in full at the time of service. (See
Fee Schedule.) You will receive a receipt from Tufts-NEMC
upon payment , which you can submit to Value Options to determine
if they will pay you directly.
Medicare and Medicaid
For medical/surgical and mental health services and post-
op services, please contact Member Services to determine what
the coverage guidelines are. You will be responsible for obtaining
a referral from your Primary Care Physician (PCP) for each
visit in the Obesity Consult Center. We will be confirming
your coverage at each visit to the OCC.
Mass Health/Medicaid Mental Health
When our department schedules your initial appointment, our
support staff will call MassHealth directly and see if you
have coverage. This is only done for patients who have MassHealth
and do not have a secondary insurance. Patients who have MassHealth
and a secondary insurance will be responsible for obtaining
their own authorization/referrals through their PCP or insurance
before their visit.
Medicare Mental Health
Patients with Medicare should first call Medicare directly
and find out what their mental health benefits are. If you
do have coverage, you must call their PCP for an authorization
number.
Mass Health/Medicaid Medical/Surgical Services
Patients must call their PCP and get approval for their visit
prior to your appointment.
Medicare Medical/Surgical Services
Patients should call Medicare and see what benefits they
have and what they need to do in getting authorization if
needed.
Network Health
This insurance company does not have a contract with Tufts-NEMC.
Patients who would like to be seen by our providers must call
MassHealth Hot Line and have their benefits changed to MassHealth
directly. This change will take 24-48 hours to go into effect
after patient has made call and been approved.
For all other Insurance Plans
Please contact the telephone number on the back of your insurance
card to determine your coverage options. It is in your best
interest to secure the coverage for all aspects of care given
in the Obesity Consult Center, including mental health services,
medical and surgical services.
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