Members pay a small copayment for services For benefit plans requiring a second surgical opinion, the member is responsible for obtaining it. A second surgical opinion is covered at the in-network level only if provided by a network provider. For hospital admissions, the provider will initiate Utilization Review. No claim forms or paperwork are required. Members present their Tufts Health Plan ID card when seeking services, and pay the appropriate copayment.
Services are subject to deductibles and coinsurance.
Members must complete and submit claim forms to Tufts Health Plan. In an emergency that requires hospitalization, members must call Customer Relations by the next business day. If a member does not initiate Utilization Review, there may be considerable benefit reductions. Emergency care is covered at the in-network level. If you stay in the Tufts Health Plan network and pay only a small copayment, tell your doctor so that he or she can send you to a network provider.