Tufts Health Plan (or Tufts/Cigna plan)
Tufts Health Plan requires BOTH a primary care physician referral AND preauthorization of coverage for speech therapy.
Do you have a deductible?
- Be aware that your deductible begins again with each new plan year. For some, this will be January 1, for others this will be based on the plan year established by your employer.
- If you have a deductible, you will pay your co-payment at the time of your visit as usual. When Harvard Pilgrim lets us know the balance due, we will bill you for your deductible amount.
Step 1: Obtain your insurance referral from your primary care physician
- Call your primary care physician's office and ask for a referral for speech therapy
- Give them our National Provider Identifier - 1558424994
- Ask for 10 visits to start
- Ask them to fax the referral to us at 781-329-2207
Step 2: Attend your evaluation
- After your evaluation, we will complete our report and request authorization for therapy. There may be a short delay in starting treatment until they respond.
- Tufts will cover your evaluation with a primary care physician's referral, regardless of whether they ultimately authorize therapy.
- Tufts excludes many childhood speech disorders from treatment coverage (they will cover and evaluation). This includes articulation (speech sound disorders), receptive and expressive language disorders and childhood stuttering.
- We are able to apply for an exception by sending in our report, however, to date we have never received authorization for these services unless there is another extensive medical diagnosis that is directly related to the speech problem.
Do you have a joint Tufts/Cigna plan? The process for authorization of therapy is the same on your end, however, your treatment is authorized by Cigna, not Tufts. Cigna typically has more limited coverage than Tufts. Coverage for treatment will be denied for therapy excluded from Cigna coverage.