Using the Plan -
How Do I Choose a Steward Primary Care Physician (PCP)?
Members under age 19 may choose any PCP from either the Steward
or Tufts Health Plan Networks. To view participating Tufts
Health Plan Pediatric PCP’s, visit Tuftshealthplan.com.
In the “Account Login” section, select “All Plans” and then
click “Start Search.”When you are asked to select a plan, choose
“I am a guest.”
When you have chosen a PCP for yourself and any covered dependents, call
Tufts Health Plan Member Services at 877-658-3640 (TDD: 800-868-5850) or
Fallon Community Health Plan Member Services at 800-868-5200 to make
Call Tufts Health Plan Member Services at 877-658-3640 (TDD:
800-868-5850) or Fallon Community Health Plan at 800-868-5200
and a Member Specialist can assist you.
Call Steward (do not use internet portal) DoctorFinder at
800-488-5959. A representative will be available to help
you choose a provider and, in some instances, book an
appointment for you.
When Do I Need a Referral?
You need a referral for most specialty services. If you do not obtain a
PCP referral prior to your visit, you may be responsible for 100 percent
of the claim. This will NOT accrue toward your out-of-pocket maximum.
Referrals to all specialists are required except for certain services
Emergency care received in an emergency room
Routine gynecological exams and medically necessary follow-up
Evaluations and related services for acute or emergency
Breast cancer screenings
Routine eye exams
What if Medically Necessary Health Services are not Available Within the
Steward Health Care Network?
Network of Providers?
While most services can be provided within the Steward Health Care
Network (SHCN). In instances where services are not available, SHCN has
contracted with Massachusetts General Hospital and Brigham and Women’s
Hospital to provide medically necessary care. If out-of-network care is
required, your PCP must complete the following two steps prior to the
out-of-network care being rendered to be covered at the in-network
Step 1: Ask your PCP to complete a standard insurance referral
Step 2: Have your PCP obtain an authorization from a Steward
referral coordinator. To obtain this authorization, your PCP
must complete an Out-of-Network Request Form and fax it to
855-676-2540 OR email it to email@example.com.
A Steward clinician will review the request and a Steward
referralrCoordinator will contact you and your PCP with written
approval or denial of such request.
Failure to obtain prior authorization for out-of-network services
will result in 100 percent member responsibility for Steward Health Plan
members. Remember that these expenses will not be credited to your
If you have any questions on the out-of-network authorization process,
wish to check if your PCP’s referral and authorization request has been
approved, or need to speak with a Steward referral coordinator, please