How will my coverage be impacted if the specific surgery or procedure being recommended by my doctor, who is a Tufts Medical Center provider, is not performed here?
While we anticipate that this will be a relatively rare occurrence, any such situation will be addressed through an appeals process managed by Tufts Health Plan. Generally speaking though, if your care is being directed by a Tufts Medical Center provider, and that provider referred you to another facility for treatment, you will be reimbursed at the Tier 1 level of benefits.
Related Questions
- The doctor charged $3,500.00 for a medical procedure and insurance company only paid $2,000.00 because they say this is the UCR amount. Can they do this and do I owe the difference?
- When should a procedure be conducted in a surgery center vs. a doctor’s office?
- Who selects a medical center and doctor for me?
