Fallon Preferred Care

Fallon Preferred Care is a preferred provider organization, or PPO, which gives you high-quality health care with welcome flexibility. Fallon Preferred Care has an extensive national and regional network comprised of hundreds of thousands of providers that gives our members the flexibility to receive care close to where they live and work. And if you want even more choices from your health plan, you can choose to see any provider—whether they are in the network or not!.

When you elect to receive care from one of the participating Fallon Preferred Care network providers, you will enjoy the highest level of coverage. If you would like to see a provider who is not a member of the Fallon Preferred Care network, or a nonparticipating provider, you’ll share a larger portion of the cost.

Highlights of Fallon Preferred Care

• An extensive national and regional network comprised of hundreds of thousands of providers
• No referral requirements for nonparticipating providers
• Prescriptions can be filled at thousands of pharmacies nationwide
• Some services require plan notification. For more details see our medical management procedures.

For more information, contact a member of our customer service team at:

800-868-5200 (TDD/TTY: 877-608-7677)
Monday through Friday
8 a.m. to 6 p.m.
contactcustomerservice@fchp.org

Medical management procedures

As a Fallon Preferred Care member, you’re not required to obtain referrals. However, precertification or plan notification is required for certain covered services, such as inpatient admissions and outpatient surgery. Requested services will be reviewed for medical necessity and appropriateness of care. This helps to ensure that complex cases are identified for care coordination and assistance. In addition, the notification and precertification process gives you the opportunity to get help in locating a participating provider, so you get the best care at the highest level of coverage.

The following services require either precertification or plan notification prior to receiving the service:

• All nonemergency inpatient admissions
• Same-day surgery
• Durable medical equipment and prosthetic/orthotic devices
• Home health care services
• Hospice care
• Infertility services
• Nonemergency ambulance transport (Note: Routine transportation to and from medical care providers is not covered.)
  

For details on your specific benefits

Call our customer service department at:

800-868-5200 (TDD/TTY: 877-608-7677)
Monday through Friday
8 a.m. to 6 p.m.
contactcustomerservice@fchp.org