Important information related to your care
At Fallon Community Health Plan, we want to be sure that you get the most from your membership. The information below can help you do just that, by reminding you of important benefits and policies.
If you have an emergency
For routine or urgent care, contact your primary care physician. However, if taking the time to contact your doctor will endanger your health, seek emergency care. Emergency services do not require referral or authorization. When you have an emergency medical condition, you should go to the nearest emergency department or call the local emergency communications system (police, fire department or 911). If you have an emergency outside of the health plan’s service area, please report the emergency within 48 hours to your primary care physician or to FCHP Customer Service, 800-868-5200 (TDD/TTY: 877-608-7677), Monday through Friday, 8 a.m. to 6 p.m. For more information emergency benefits and plan procedures for emergency services, consult your FCHP Member Handbook/Evidence of Coverage.
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Interpreter services are available
If you need an interpreter to understand our procedures when doing business with the health plan, we will make the arrangements for interpreter or translation services.
To request these services, please contact Customer Service at 800-868-5200 (TDD/TTY: 877-608-7677).
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"Utilization review" improves your care
You may hear the term "utilization review" in relation to health plans and wonder what it means. Simply put, it means that we take a closer look at the care given to our members, to ensure that services are being used, or utilized, in the best possible manner.
In utilization review, teams of health care professionals at an HMO like Fallon Community Health Plan review patient treatment histories to determine if the care given was medically necessary, efficient and appropriate—and then look for ways to improve all three areas in similar future cases.
We’d like you to know that Fallon Community Health Plan does not reward practitioners or other individuals for denying coverage or service when they conduct utilization reviews. There are no financial incentives that encourage our utilization team to make decisions that would unnecessarily restrict appropriate services. All such decisions are based only on appropriateness of care and service.
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We treat all members equally
Fallon Community Health Plan wants you to know that it will not discriminate against its members based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information or source of payment.
All Fallon Community Health Plan employees—clinical, contracted and otherwise—are committed to treating all members equally in all circumstances.
If you have any questions about Fallon Community Health Plan policies or procedures, contact Customer Service at 800-868-5200 (TDD/TTY: 877-608-7677), Monday through Friday, 8 a.m. to 6 p.m.
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Post-mastectomy benefits
Fallon Community Health Plan provides benefits for mastectomy-related services, including: reconstruction of the breast affected by a mastectomy; surgery and reconstruction of the other breast with the goal of producing a symmetrical appearance; treatment of physical complications of all stages of mastectomy; and prosthesis. For more information, contact Customer Service at 800-868-5200 (TDD/TTY: 877-608-7677), Monday through Friday, 8 a.m. to 6 p.m.
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