Frequently asked questions
What is Wellforce Care Plan?
Wellforce Care Plan is a MassHealth Accountable Care Organization (ACO) Partnership Plan. It is made up of the Wellforce Care Plan ACO and Fallon Health. The Wellforce ACO is a group of hospitals and providers who have agreed to work closely together to take good care of you and your family. Fallon Health is a leading health care services company that has been caring for MassHealth members for more than 40 years.
Wellforce Care Plan is made up of physicians and other health care providers from, or affiliated with:
- Circle Health
- Floating Hospital for Children at Tufts Medical Center
- Lawrence Memorial Hospital (Hallmark Health System)
- Lowell Community Health Center
- Lowell General Hospital
- Lowell General Physician Hospital Organization
- Melrose-Wakefield Hospital (Hallmark Health System)
- New England Quality Care Alliance (NEQCA)
- Tufts Medical Center
As a member of the Wellforce Care Plan, all of your health care is managed by your primary care provider (PCP). Your PCP will work with Wellforce Care Plan’s group of doctors, hospitals and community health centers to provide you with great health care.
What is an Accountable Care Organization (ACO)?
An ACO is a group of providers who agree to work closely with patients and their families for all of their health care needs. Doctors and other health care providers choose to participate in an ACO because they are committed to providing patients with a better care experience. In an ACO, your PCP is responsible for coordinating your care and connecting you with available services and supports. This coordination will help you get the right care at the right time in the right place.
How can I be sure my primary care provider (PCP) is part of Wellforce Care Plan?
To be sure that your PCP is in the Wellforce Care Plan network, click the link below. You can also call Fallon Health at 1-855-508-4715 (TRS 711) from 8 a.m to 6 p.m., Monday – Friday.
Do I need to get a referral to see a Wellforce Care Plan specialist?
Yes. Because Wellforce is made up of many provider practices, you will have to get a referral from your PCP to see a Wellforce Care Plan specialist. You will also need to get a prior authorization from your PCP to see an out-of-network specialist.
How do I join Wellforce Care Plan?
To join Wellforce Care Plan you must:
- Qualify for MassHealth
- Have a Wellforce primary care provider
- Live in one of the cities or towns in our service area
If you meet the requirements above, call MassHealth to enroll. They can be reached at 1-800-841-2900 (TTY: 1-800-497-4648). They’re available 8 a.m. to 5 p.m., Monday through Friday. Or, visit MassHealthChoices.com
If you are currently pregnant, in treatment, or have an upcoming surgery, call us at-1-855-508-4715 (TRS 711) to let us know. We will work with you and your providers to avoid any interruptions to your care.
Will I pay more for Wellforce Care Plan?
No. There’s no cost to join Wellforce Care Plan.
How does Wellforce Care Plan work?
You are covered for many important health care services, including behavioral health services and free rides for emergencies. You’ll also get:
- $10 CVS Select gift card when you fill out your health survey
- A free car seat, and other “little extras” for expectant parents through the Oh Baby! program
- A free online health resource with info on conditions, medicines and other health topics
- Free help for people with asthma, heart disease, diabetes or chronic obstructive pulmonary disease (COPD)
Wellforce Care Plan can also help you get behavioral health counseling services. They can teach you about children’s services. And they can show you how to apply for food stamps and other benefits.
Will I be able to continue to see my specialists?
If you have a Wellforce Care Plan PCP, and your specialists are part of the Wellforce Care Plan network, you will be able to continue to see your specialists with a referral from your PCP. To be sure that you can continue to see all of your doctors, you must make sure that they are in the Wellforce Care Plan network. You can do that by calling Fallon Health at 1-855-508-4715 (TRS 711) from 8 a.m. to 6 p.m., Monday through Friday. Or, you can look up doctors online using the "Find a doctor" link below.
If your specialist is not a part of the Wellforce Care Plan network, you will need to contact your PCP to determine if you can continue to see this specialist. You may need a referral or a Prior Authorization for some of your providers.
What is My Ombudsman?
My Ombudsman is an independent organization that helps individuals, including their families and caregivers, address concerns or questions that may impact their experience with a MassHealth health plan or their ability to access their health plan benefits and services. My Ombudsman works with the member, MassHealth, and each MassHealth health plan to help resolve concerns to ensure that members receive their benefits and exercise their rights within their health plan.
My Ombudsman is knowledgeable about member rights, contractual requirements of each health plan, benefits and services available to members, as well as resources in the community. My Ombudsman is able to connect with representatives at health plans and at MassHealth to investigate and resolve concerns quickly and appropriately.
Office: 11 Dartmouth Street, Suite 301, Malden, MA 02148. Office is wheelchair accessible.
Walk-in hours: Mondays 1 p.m.–4 p.m. and Thursdays 9 p.m.–12 p.m. and by appointment.
Questions about Wellforce Care Plan?
Call us at 1-855-508-4715 (TRS 711) from 8 a.m. to 6 p.m., Monday – Friday.
Questions about MassHealth?
Call MassHealth at 1-800-841-2900 (TTY: 1-800-497-4648). They are open 8 a.m. to 5 p.m., Monday through Friday. Or, visit MassHealthChoices.com.