Tufts Health Plan

I received a notice in November that my November bill was not paid. I had paid it online and Tufts had deposited it. This started a number of calls, at least six, until I was told to contact my bank, BofA, and send them proof. I was told the address to send it to. I did that and had the bank send me a copy also. I called Tufts again and they said they did not get info from bank. I spoke with Marshall who gave me a different address to mail it to his attention. I made a copy from the info bank had sent us both and mailed it. I heard nothing from Marshall although I called and left voicemails twice. I called again and spoke to Maria who said they got info and she would call when the November payment was applied. She did call back and I thought we were done.

Today, 1/3/12, I received a letter from Tufts saying they had not received December payment which had never been in question and was posted by Tufts on Dec 1. I called Tufts and spoke with Midaglia who said that was a mistake and I owed no back payments. She said she would file a grievance. This has been an awful thing to go through during the holidays. I worry that my health insurance would somehow get cancelled. I spent hours trying to get help from Tufts, dealing with my bank and this is all due to some shortcomings at Tufts and they're not handling my payments correctly. If it were not too late, I would change my health plan because I now have no confidence in Tufts billing dept and am not sure this will ever end.

In October 2010, my son had to go to Children's hospital to a neurologist for severe migraine. The Dr. then gave us some instructions to follow and a follow up in February 2011. The Dr.'s office called in January to get more info on our insurance. I called them back and the gentleman at children's said he tried to pre-qualify or insurance and it was no longer valid. I said that is right it has changed and is now Tufts, do you take that and he said yes. This was a whole month before his appointment.

We went to his follow up in February and the Dr. wanted to do an MRI. So we scheduled that which was a bout 2 to 3 weeks later. We received a letter from a company called NIA which is a vendor for Tufts who reviews requests for MRI's for them to be sure they are authorized. The letter stated that they had reviewed the request and it was authorized and certified. This was prior to having it done. Well, a few weeks later, we started getting statements for tufts that they were not covering the Dr.'s appointments, MRI or The radiologist. After calling them, they said he was not in our network.

We did not realize that we were limited to a network or were out of it for this Dr. We also were under the impression we had coverage of 80% if we choose a Dr that was not on their preferred list. We were told that is a different policy and we somehow were enrolled in the wrong one. Children's said its not their fault they have so many insurance companies they deal with and don't know who they take or what's covered. Children's said they took the insurance and we expected to be covered. They verified coverage on my old policy, why not my new one? Tufts vendor sent us a letter saying the MRI was authorized and certified. I was not given an opportunity to deny their services for my son if it was not being covered. I think Children's and Tufts use deceptive and dishonest practices. I can just imagine how many other people they have done this to.