Business Profile

HMOs

Tufts Health Plan

Headquarters

This business is NOT BBB Accredited.

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Complaints

This profile includes complaints for Tufts Health Plan's headquarters and its corporate-owned locations. To view all corporate locations, see

Customer Complaints Summary

31 total complaints in the last 3 years.
10 complaints closed in the last 12 months.

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The complaint text that is displayed might not represent all complaints filed with BBB. Some consumers may elect to not publish the details of their complaints, some complaints may not meet BBB's standards for publication, or BBB may display a portion of complaints when a high volume is received for a particular business.

Initial Complaint
Date:03/01/2025
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I am diabetic and I have liver damage. Twice has my doctors office submitted a prior authorization for my medication and twice has beed denied.I have called countless times to no avail. I kept getting transferred to another department every single time with the same excuse. Ah its ********* sob its a different department. I believe Tufts is purposely denying prior authorization claims to ******** recipients. Additionally, another prior authorization was also submitted for my psoriasis and was also denied. Unfortunately, due to the damage in my liver I am not a candidate for alternative treatments.
Business Response
Date: 03/03/2025
Good Morning,
Complaint received by plan, currently being researched and will have a response within 30days.
Customer Answer
Date: 03/03/2025
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[A letter I received in the mail clearly stated that I had the option to ask my doctor to keep taking it. (Copy of letter enclosed) I have been taking this medication since March 2023 (2 years now) and its working. My doctor submitted the prior authorization twice and now you want me to wait 30 days for a response from you? What am I supposed until then?]

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
Emme Wandris

Business Response
Date: 03/04/2025
Appeals and Grievance analyst is investigating the member's concerns and has made outreach attempts. Analyst will continue to process the complaint and will respond accordingly.
Customer Answer
Date: 03/05/2025
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
I spoke to Mr. ******* this morning. He will be kind enough to assist me with the process of filing an appeal to get the medication approved and/or covered by the plan. Additionally, he agreed to circle back with me sometime today with an update.

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
Emme Wandris
Initial Complaint
Date:02/05/2025
Type:Product Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I was approved to join in network as a group provider (Mieljade Behavioral Health) with Tufts in March 2024. I have been requesting a copy of my fee schedule and contract since March 2024 and still have yet to receive a copy. After multiple phone calls since March, I took the advise of Tufts representative and have reached out to the following emails to request a copy:******************************************************************************** **************************************************** *********************************************** Noone has responded except receiving an automated email receipt acknowledging that my request was received. I have also filed a complaint through BBB and see that Tufts responded to the complaint on 1/8/25 that they will reach out to the appropriate department and yet still no response. At this point I am filing a complaint against them to the state commissioner because at this point this is absurd! Tufts send me a copy of my fee schedule and contract. Many organizations are complaining about your lack of responsiveness and customer service and find the company to be unbearable.
Business Response
Date: 02/06/2025
Please provide date of birth or member ID number so that we can identify the member and begin the grievance process. Once we have the requested information, we will be able to set up and process the grievance.
Thank you,
Customer Answer
Date: 02/06/2025
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
I did not receive the appropriate response to my compliant which was "Please provide date of birth or member ID number so that we can identify the member and begin the grievance process. Once we have the requested information, we will be able to set up and process the grievance.
Thank you,"

I am not looking to start a grievance process. I am simply requesting for a copy of my contract and fee schedule as I was approved to join in network with Tufts on 3/2024. Please just forward me my contract and fee schedule IMMEDIATELY!

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
*****
Initial Complaint
Date:01/06/2025
Type:Order Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I was approved by Tufts to contract as an in-network group provider for Mieljade Behavioral Health LLC starting in March 2024. I received the contract via an encrypted email portal, but shortly after, the email vanished, leaving me without access to my signed contract and fee schedule. Apparently emails sent by Tufts have a short time limit and will be removed. Despite my repeated attempts to contact Tufts by phone and email since March 2024, I have been met with delays and only been told to expect a response within 30 days. Now, in January 2025, I still have not received a copy of my signed contract or fee schedule. This lack of response is unacceptable and has prevented me from servicing Tufts clients. I require immediate action to resolve this issue.
Business Response
Date: 01/08/2025
Good Morning,
Please be advised that your complaint has been forwarded to the correct department for review.

Thank you
Initial Complaint
Date:12/06/2024
Type:Service or Repair Issues
Status:
UnresolvedMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I was incorrectly placed into Tufts Health Direct through the health connector. I appealed the decision and was then correctly placed into MassHealth with Wellsense.The Health Connector is incompetent and seems completely unable to communicate with you about this and there is nothing else I can do. There have been numerous calls and nothing has been ************** / communicate with the health connnector and please remove this Tufts insurance because I am not in this plan and the health connector is not even paying you premiums. It is causing me significant issues because ********* sometimes denies claims, stating that I have Tufts as primary insurance....
Business Response
Date: 12/09/2024
Hello, the health plan has received the grievance and will provide a response within 30 days.
Thank you.
Customer Answer
Date: 12/09/2024
This was just a notice that a response will be provided later. As the matter is still open, it should not be closed.

More importantly, hopefully the issue will be sorted out.

Thanks,
-****

Customer Answer
Date: 12/29/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
All that happened is they said they would reply later. I have not heard anything since and this is not resolved nor have they provided you their position....
Initial Complaint
Date:11/08/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I was requested by my doctor to get a blood test on 2/16/24 as I had been diagnosed with a blood clot in July 2023. This test was to determine if the clot was hereditary and to test for a PT COAG FACTOR according to the bill. Tufts denied the claim stating a pre-authorization was not received by my doctor. Quest Diagnostics sent me a bill for $570.46. I contacted Quest and Tufts in April 2024. I explained this was not my responsibility as I don't send pre-authorization, this would need to have come from my doctor. Tufts contacted Quest and informed them not to send me any more bills and that Quest would need to write this off. I contacted my doctor's office to send a pre-authorization which they did in May, June, August and October of this year. I've contact Tufts numerous times to get this resolved. Every time I do, I get a different answer. On 10/18/24 I spoke with ********* *. who said he would file an expedited appeal, but then told me the claim had been paid on 3/5/24 under payment# ******** and he would contact Quest and then call me back; he never did. I spoke with ***** *. on 10/25/24 who filed an appeal for me and said this was not resolved. on 10/28/24 I spoke with ******* *. who told the appeal was processed and Quest would be informed not to send me any more bills, Quest needs to write it off and I am not responsible for the bill. She said she would call me back; she never did. On 11/4/24 I spoke with ******* *. who gave me appeal# A2429990029 and said the appeal was in process. On 11/5/24 I was contacted by the ************* at Tufts who asked for more information which I gave them, but basically said I did not have a pre-authorization and I was out of network when I had the bloodwork done as I was in ******* at the time. I asked how could that be? This is Quest Diagnostics, not a doctor's office. Still, the appeal was under review. Tufts always gives me a different answer every time I call and I keep getting billed from Quest.
Business Response
Date: 11/08/2024
Hello,
Complaint received by plan, currently being researched and will have a response within 30 days.
Thank you,
*** *******
Customer Answer
Date: 11/09/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
[You must provide details of why you are not satisfied with this resolution. If you do not enter a reason for your rejection, your complaint will be closed as Answered.]

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ
This should have been resolved in April 2024. Tufts just keeps kicking the can down the road and delaying. This is the latest example of their delay tactics. The bottom line is I should not be responsible for this bill. I did everything I was told to do by Tufts and was told on more than one occasion either this was resolved or I would not have to pay or it was settled and Quest will no longer be sending me a bill. None of this has happened. Now, this is in an appeal? I was told the appeal would be expedited and resolved in 3 days. Then I was told the claim was paid. Then I was told the claim was not paid. Then I was told the appeal had been processed and Quest would be told not to send me any more bills. This also turned out to be wrong. After another call I was told the appeal had NOT been processed. Now I'm told this is in appeal and could take up to 30 days. This is unacceptable. Tufts, and others, incompetence is not something I should have to pay for. This bill should have been resolved by Tufts, Quest Diagnostics and my doctor's office. I don't think you need an appeal to figure that out from the history of this complaint that I detailed. Tufts doesn't want to pay; Quest Diagnostics keeps sending me the bill in the hopes I will pay it. Again, I have been fighting this for 9 months with no resolution. Tufts needs to settle this with Quest Diagnostics so they will stop harassing me with a bill that Tufts should have resolved back in Apil 2024.

Regards,
******* ******

Business Response
Date: 11/22/2024
the grievance is currently in process, and we will respond to the member within 30 days.
Customer Answer
Date: 12/03/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********.
Once again, this response from Tufts Health underscores the complete and total incompetence of their customer service group. Not surprisingly, they seem to be confused on the difference between an "appeal" which is what they stated originally when I filed this complaint with the BBB and a "grievance" which I filed twice with Tufts. This is due to the fact the first grievance I filed was ignored. As per the attached document detailing the complaint. I received a letter and then a phone call from ******* *******, Appeals and Grievance Analyst at *******************. He left me a message and asked me to call him back as he wanted to get more information. I received a letter from him with Case# G24290244708. I called him back three times and left him messages. He never called me back. So, I filed a subsequent grievance against him and Tufts.
I received a letter on 11/20/24 from Tufts Appeals stating my appeal was denied. Part of this was due to I was "out-of-network" when I had the bloodwork done in *******. This was at a Quest Diagnostics, not a doctor's office. But, that was part of their reasoning. This is like stating you can go to a ********* station, but only the ones in network. I send a letter (attached) detailing this entire experience on 11/10/24 to ******* *****, **************** Manager or an appropriate customer service manager. Again, unsurprisingly, I have heard no response. It was difficult to merely find ******* ***** or any customer service manager.
So, perhaps Tufts doesn't quite understand the difference between an "appeal" and a "grievance". But yes, the subsequent grievance is in process.
The only resolution I will accept from Tufts is the payment of my claim for $570.46 from Quest Diagnostics if for nothing more than their gross incompetence, negligence and mis-information over the past 9 months.

Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
******* ******
Initial Complaint
Date:06/26/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
for at least the past year I have asked for tufts health plan to reimburse planet fitness fee they cover for $150 dollars., This began January 17, 2023, and I have called on 5 occasions for checks that were supposedly sent but never were, and they were voided then reissued three times, each time asked to recheck in the issue with ********, ********, ********, innumerable **** so nice to give me their direct extension only to have a few months go by with no check each time. I have dealt with insurance agencies all my life and this is an all time embarrassment on behalf of the providers that dismiss their clients. I would like my $150 dollars plus an explanation from the president of their company as to how this could happen recurrently so many times. Shameful.
Business Response
Date: 06/27/2024
Please note that this complaint has been assigned to an analyst to process/research. resolution will be made within 30 days.
Initial Complaint
Date:05/31/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
We filed a reimbursement claim about 4 months ago. More receipts were requested and they were filed. ******************** from tufts personally told me 2 to 3 times that he's looking into this and will personally respond back. Despite many calls and long hold times, no resolution has occurred. I also have an acupuncture claim in the system that has not been responded to.Tufts customer support has gotten much worse, worthy of a 1 star rating.Thanks Atul
Business Response
Date: 06/03/2024
Complaint has been assigned and will be researched. Response will be provided in writing within 30 days of receipt.
Customer Answer
Date: 06/03/2024
Please leave this complaint open as the issue will still not be resolved for 30 days. Tufts has been extending a resolution to the issue in this manner.
I want to hold them accountable till the issue is resolved to my satisfaction. Currently it is still open.
Regards,

*********************
Customer Answer
Date: 06/27/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.

To this day, I have not received a single message from Tufts ******** on this issue.

Please follow up and investigate.

Thanks
Atul Pandya
Business Response
Date: 06/28/2024
Response letter sent today. The letter recapped call history, advised reimbursement request was denied due to not be a covered benefit per Evidence of Coverage (EOC), acupuncture benefit quoted, appeal rights offered as well as financial assistance options.
Customer Answer
Date: 07/01/2024
Better Business Bureau:I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********. Please add your rejection comments below; if you do not provide any details, your complaint will be closed as Answered.
This claim is about my wife, ******'s weight management claim and not for my acupuncture claim.
Her weight management claim still lies unpaid for 4 to 5 months. Tufts has been mismanaging the claim and still hasn't paid it.
Please keep this complaint open to pressure tufts to pay a legitimate claim.
Thanks
Atul
Businesses and Customers should be civil, courteous and polite in their responses to complaints. It is important to remain professional and productive when participating in the BBB complaint process.

FAQ

Regards,
Atul
Initial Complaint
Date:05/09/2024
Type:Customer Service Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I run a small outpatient mental health practice. Within the last year Tufts claims I received an overpayment and is withholding payment for current work to recoup their overpayment. I have called several time attempting to gain some transparency around the issue such as, how much was the overpayment, how much is left to recoup, when do they expect the account to be settled. This issue has been going on since December of 2023. Each time either myself of a ****** calls on my behalf we are told they can not give out that information or I will receive a fax in five business days. No fax is ever received and no transparency is gained. I see several of Tufts insured clients on a weekly basis. The overpayment should be satisficed by now. However, I continue to receive no payment and no insight to where we stand. I would to receive clear communication on how much I was overpaid, and a detailed record on how much has been recouped to this point and a clear projection on when the account will be settled
Business Response
Date: 05/10/2024
Plan has received complaint. Plan will review and provide an update. ED
Initial Complaint
Date:04/18/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
Currently - and at least since January 2024 -- Tufts Health Plan has no way for an insured person to delete or change their direct deposit information with Tufts for claims reimbursement.This is an issue both on the Tufts insured person portal AND if you call their call center.In January 2024, I closed my bank account associated with my Tufts Health Plan reimbursement deposits. This week (April 17, 2024) was the first time I had claims processed by Tufts that I submitted directly which resulted in monies owed to me. Tufts is claiming these monies have been direct deposited to my account - however, this account is closed.I need Tufts to REMOVE my direct deposit information from my account so I just receive checks.At this point, Tufts has left me no options to receive my over $1,200 owed to me -- and this is only a problem because of their inadequate IT systems.A suggestion today from Tufts was to call PaySpan their vendor -- I am not spending time speaking with a 3rd party vendor that Tufts has contracted with because of their own inadequate systems.What do you consider to be a fair resolution?: Remove my direct deposit information so future reimbursements for claims come as a check. Current issues are with claim numbers 459202RS, 453500AX, and 456100FF. Tufts claims that I have been reimbursed the $1,248.00 owed to be via direct deposit. That's impossible because the account the are claiming they used has been closed for 3 mos. And they have no way for me to delete the account from their systems OR change my account
Customer Answer
Date: 04/29/2024
I have not heard from the business in response to my complaint.
Business Response
Date: 04/29/2024
Plan has received complaint and will assign and investigate. **
Customer Answer
Date: 04/30/2024
I have reviewed the response submitted by the business and have determined that the response does not satisfy or resolve my issues and/or concerns in reference to complaint # ********.

The response from the business is that they will assign someone to look into this issue I agree that this is a first step. But this does not mean that the issue should be closed as resolved. Its not resolved. I will agree to close this issue once I receive a substantive response from the business with a resolution - not just a promise to investigate.

Regards,
*********

Business Response
Date: 04/30/2024
The consumer's complaint has been forwarded to the plan's Ancillary Network Contracting Team for further investigation as the Appeals and ********************* does not investigate provider concerns. Appeals and Grievances handles member/beneficiary concerns/complaints. For Medicare Provider Services, the consumer can call: Provider Services at: **************. Public Plans Provider Services: **************. Commercial Provider Services: **************.
Customer Answer
Date: 05/01/2024
I am rejecting this comment as its not a resolution. Its a communication that the issue is being passed on to another department. Rejecting this response will keep this issue open.
Initial Complaint
Date:04/03/2024
Type:Service or Repair Issues
Status:
AnsweredMore info
Complaint statuses
Resolved:
The complainant verified the issue was resolved to their satisfaction.
Unresolved:
The business responded to the dispute but failed to make a good faith effort to resolve it.
Answered:
The business addressed the issues within the complaint, but the consumer either a) did not accept the response, OR b) did not notify BBB as to their satisfaction.
Unanswered:
The business failed to respond to the dispute.
Unpursuable:
BBB is unable to locate the business.
I have been a provider for Tufts for several years. Last year I opened my own office and attempted to get that business in network. Over the past several months, I have sent many applications, emails and left many messages with Tufts ********************** and have yet to hear from a representative. I have several Tufts members that I am unable to treat due to this situation. It is disheartening to say the least that a health plan could treat not only a loyal provider in such a way, but also their members that are devoted to their health care.
Business Response
Date: 04/29/2024
Complaint has been received and will be assigned to an analyst for investigation and processing. We apologize for the delay.

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