Tufts Managed Medicare Referral Policy

Tufts Medicare Preferred Out-of-Network Referral Policy

At Healthy Aging Physical Therapy, we are proud to offer Outpatient Physical and Occupational Therapy services delivered in the comfort of your home. While we are out-of-network with Tufts Medicare Preferred, patients with this plan still qualify for in-network coverage of our services through their out-of-network benefit.

How to Access Our Services Using Tufts Medicare Preferred

Tufts Medicare Preferred allows patients to receive medically necessary services from out-of-network providers at in-network rates, when your Primary Care Physician (PCP) submits an Out-of-Network Referral for our services.

Here’s what your PCP needs to include in the referral:

Our Scheduling Policy

To ensure we can provide the best care possible and avoid scheduling delays:

  • We are unable to schedule your evaluation until we have received notification the referral approval.

  • As a courtesy, our team will fax your PCP instructions and follow up by phone to assist with the process.

  • If the referral is not received within two weeks, we will notify of you the delay and request that you call your PCP’s office directly to request the referral or encourage them to complete our request.

What to Say When You Call Your PCP

If you need to follow up with your PCP, here’s what you can tell them:

"I’d like to request an Out-of-Network Referral for outpatient physical or occupational therapy at home to be provided by Healthy Aging Physical Therapy (NPI 1366050106). The referral must be submitted using the WB Mason Out-of-Network Referral form and faxed directly to Tufts at (617) 972-1028."

Need Help?

We’re happy to assist you and your PCP through the process. If you or your PCP have any questions, please call our office at (617) 398-4058 Monday–Friday, between 9:00 AM and 3:00 PM.

What If My Request to See Healthy Aging Physical Therapy Is Denied?

If your request to receive physical or occupational therapy services with Healthy Aging Physical Therapy is denied by your primary care provider (PCP), medical group, or insurance medical director—you still have options.

Many patients don’t realize that you have the right to request a review directly from your insurance company. This is called an Organizational Determination. This is a formal request for your insurance company (such as Tufts Health Plan) to review a decision about your care.

You can request this if:

  • Your referral to a specific provider (like Healthy Aging PT) was denied

  • You were told services are not medically necessary

  • You were directed to a different provider, but prefer to receive care with us

This process allows the insurance company—not just your doctor’s office—to review your case and determine whether your requested care should be approved.

Why This Matters

At Healthy Aging Physical Therapy, we provide specialized outpatient-at-home care that is often not available in traditional clinic settings. For many of our patients—especially those with:

  • Parkinson’s disease

  • Neurological conditions

  • Balance and fall risk concerns

  • Difficulty leaving the home

…our model of care is not just a preference—it can be the most appropriate and effective option.

How to Request an Organizational Determination (Tufts Health Plan)

You (or a family member/caregiver) can call Tufts Health Plan directly and request this review:

  1. Call the Member Services number
    (This is on the back of your insurance card)

  2. Tell them:

    “I would like to request an Organizational Determination for outpatient at home physical (or occupational) therapy services with Healthy Aging Physical Therapy.”

  3. Be prepared to provide:

    • Your member ID number

    • The name of the provider: Healthy Aging Physical Therapy (HAE/PT, LLC)

    • Our NPI Number: 1366050106

    • Our fax number: (781) 262 3337

    • The type of service: Physical Therapy and/or Occupational Therapy at Home

    • A brief explanation of why you are requesting care with us in particular

  4. Once you speak with Tufts, please call us at (617) 398 - 4508 and let us know the result and if approved, we would be happy to schedule your care.