Why are the copays higher for Tiers 2 and 3, when I am still required to use Tufts Health Plan participating providers?
The cost to the plan for your care in most cases is higher whenever it is received outside of Tufts Medical Center and our affiliated providers. Since our primary focus has to be on helping to control costs for all plan participants, we are increasing the out-of-pocket costs for those members who choose to receive their care elsewhere. Q9: If I am under the care of a physician who is not located at Tufts Medical Center, can I still receive services at Tufts Medical Center and be reimbursed at the Tier 1 level of benefits for those services? Yes, absolutely. You should ask your doctor to send you to Tufts Medical Center whenever possible, whether it is for lab tests, x-rays, or other outpatient treatment, so that you can access the higher level of benefits under Tier 1. However, in order for an inpatient hospitalization to be considered reimbursable at the Tier 1 level of benefits, your doctor must have admitting privileges at Tufts Medical Center. Q10: I have had trouble getting an app
