Members of all of the UniCare State Indemnity plans and Tufts Health Plan Navigator and Spirit plans have their mental health and substance abuse benefits through United Behavioral Health (also known as OptumHealth or UBH). The GIC's other health plans use other mental health plan networks, including Harvard Pilgrim Health Plan, which also uses UBH, but under its own contract. When you or a covered family member need help for depression, stress, anxiety, substance abuse or another mental health service, using a UBH network provider helps you maximize your benefits and provides peace of mind. UBH providers go through a rigorous credentialing process, so you will know you have a top quality provider. Using one of these providers also significantly reduces your out-of-pocket expenses. (Tufts Health Plan Spirit members do not have out-of-network benefits and only receive benefits for in-network coverage.)

Network clinicians offer the following quality advantages:

  • Rigorous selection and credentialing: Each clinician and inpatient facility must meet UBH's high standards for participation.
  • Ongoing review: Clinicians and facilities are reassessed periodically through site and chart audits.
  • Outcomes monitoring: Clinicians work with UBH's team to monitor clinical outcomes of care to be sure members are getting the best treatment in the most appropriate setting.
  • Clinician matching: UBH works with members to find clinicians who best meet individual clinical, cultural and geographic needs.

"Every member's mental health and substance abuse needs are unique," said David Nefussy, UBH's Director of Provider Relations. "With a network provider, the member is assured that the clinician's education and licensing has been verified and that the clinician's training, background and expertise best addresses the member's unique problem."

Members save money when they use participating providers. Here are savings examples for a Tufts Health Plan Navigator member.



Savings Examples In-Network vs. Out-of-network

These illustrations do not take into account any calendar year deductible costs and actual costs and utilization will vary from the assumptions listed

Tufts Health Plan Navigator member

In-network provider - member pays

Out-of-network provider - member pays

Outpatient care - 8 visits - total cost of $1,000

$160

$200

Acute Inpatient Care - 7 days - total cost of $7,000

$200

$1,400

Residential treatment for substance abuse - 10 days - total cost of $5,000

$200

$1,000

UniCare State Indemnity Plan members' savings for using network providers are similar, but copays and deductibles vary slightly by plan. Tufts Health Plan Spirit members do not have out-of-network benefits.

"It's usually in the member's best interest - both from a coordination, quality of care and financial standpoint - to use network providers and we will work with the member to find the best provider for their needs," said Mr. Nefussy.

To find a provider, call UBH at 1-888-610-9039. Or, visit their website and enter access code 10910. The website has many provider search options including searching within a certain number of miles of a city or zip code, by clinician name, the type of clinician (e.g., psychologist), gender, ethnicity, areas of expertise (e.g., post traumatic stress syndrome, etc.), language spoken, and location features, such as evening appointments and public transportation access.


This information provided by the Group Insurance Commission.