Tufts Medicare Preferred

Receiving Physical or Occupational Therapy with Healthy At Home

Healthy At Home Physical Therapy provides outpatient physical and occupational therapy in the comfort of your home.

Healthy At Home is not currently an in-network provider with Tufts Medicare Preferred HMO plans. However, Tufts Medicare Preferred HMO members may be able to receive services from an out-of-network provider when the appropriate referral and/or authorization is obtained before services begin. Because every plan and situation can be different, we will work with you to determine what is required before scheduling your evaluation.

How Do I Receive Care with Healthy At Home?

Tufts Medicare Preferred HMO plans generally require your Primary Care Physician (PCP) to coordinate your care.

If you would like to receive outpatient physical or occupational therapy with Healthy At Home, your PCP may need to request an out-of-network referral and/or authorization from Tufts Medicare Preferred specifically for our practice.

Your request should identify:

Healthy At Home Physical Therapy, LLC
Service Requested: Outpatient Physical Therapy and/or Occupational Therapy provided in the patient's home
NPI: 1700461936

Your PCP should indicate that you are requesting services specifically with Healthy At Home Physical Therapy rather than a general referral for physical or occupational therapy.

Before We Schedule Your Evaluation

Because Healthy At Home is out-of-network with Tufts Medicare Preferred HMO, we must confirm that the appropriate referral and/or authorization has been approved before your evaluation.

This protects you from unexpectedly receiving services that your insurance may not cover.

Once we receive confirmation that the necessary approval is in place, our office will contact you to schedule your evaluation.

What Should I Say When I Call My PCP?

You can tell your PCP's office:

“I would like to receive outpatient physical/occupational therapy at home from Healthy At Home Physical Therapy. Healthy At Home is out-of-network with my Tufts Medicare Preferred HMO plan, so I need my PCP to request the appropriate out-of-network referral or authorization from Tufts Medicare Preferred specifically for Healthy At Home.”

What If My PCP Will Only Refer Me to an In-Network Provider?

Tufts Medicare Preferred HMO plans use a network of providers and PCP referral circles. Your PCP may initially recommend that you receive therapy from an in-network provider.

However, if you believe Healthy At Home is particularly appropriate for your needs, you can ask Tufts Medicare Preferred to review whether your requested care can be provided by Healthy At Home.

One way to do this is by requesting an Organization Determination.

An Organization Determination is a formal decision from your Medicare Advantage plan about whether it will cover or pay for a healthcare service you are requesting.

You may want to request a review if:

Your request to receive care from Healthy At Home was not approved.
You were directed to another provider but believe that provider cannot adequately meet your needs.
You need outpatient therapy provided in your home and are having difficulty accessing an appropriate in-network option.
There are specific clinical or accessibility reasons why receiving care from Healthy At Home may be appropriate.

Approval is not guaranteed. Tufts Medicare Preferred will review the circumstances and make a coverage decision based on your plan and individual situation.

Why Might I Request Healthy At Home?

Healthy At Home specializes in bringing outpatient physical and occupational therapy directly to patients in their homes and communities.

For some individuals, receiving care at home allows therapy to address challenges that may be difficult to fully assess or treat in a traditional clinic.

This may be particularly helpful for individuals with:

Parkinson's disease or other neurological conditions.
Balance problems or a history of falls.
Difficulty safely leaving or accessing a traditional outpatient clinic.
Mobility limitations.
Difficulty with everyday activities in their actual home environment.
A need for caregiver training or assessment of the home environment.

When requesting Healthy At Home, it may be helpful to explain why receiving outpatient therapy in your home is important to your individual needs and why the available in-network options may not meet those needs.

How Do I Request an Organization Determination?

You or your authorized representative can contact Tufts Medicare Preferred Member Services using the telephone number on the back of your insurance card and ask how to request an Organization Determination for services with an out-of-network provider.

You can say:

“I would like to request an Organization Determination for outpatient physical and/or occupational therapy provided in my home by Healthy At Home Physical Therapy.”

Be prepared to provide:

Your Tufts Medicare Preferred member ID.
Healthy At Home Physical Therapy, LLC as the requested provider.
Our NPI: 1700461936
The requested service: Outpatient Physical Therapy and/or Occupational Therapy provided in the home.
The reason you are requesting Healthy At Home specifically.
Any relevant information about why available in-network services do not adequately meet your needs.

If Tufts requests clinical information or documentation from Healthy At Home, please let us know and our office will assist when appropriate.

If Your Request Is Approved

Please contact Healthy At Home once you receive notification that your out-of-network request has been approved.

We will verify the authorization and its requirements directly before scheduling your evaluation.

Authorization may include limitations such as a specific number of visits, date range, or type of service. Receiving authorization also does not guarantee payment; services must continue to meet your plan's coverage requirements.

We're Happy to Help

Insurance referrals and authorizations can be confusing. Our office is happy to help you and your PCP navigate the process and provide the information needed to request services with Healthy At Home.

Healthy At Home Physical Therapy, LLC
Phone: (978) 684-2106

Fax: (413)206-7043
NPI: 1700461936

Coverage and authorization requirements vary by individual Tufts Medicare Preferred plan. Approval of out-of-network services is determined by Tufts Medicare Preferred. Patients should confirm their individual benefits and coverage with Tufts Medicare Preferred before receiving services.