Fallon Preferred Care network

Our Preferred Care network is a PPO network that includes doctors and facilities throughout Massachusetts, New England, and across the nation.

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 (out-of-network), or a non-participating provider, you’ll share a larger portion of the cost

Fallon Preferred Care features

• An extensive national and regional network comprised of hundreds of thousands of providers
• No referral requirements
• Prescriptions can be filled at thousands of pharmacies nationwide
• Some services require plan notification:
• All nonemergency inpatient admissions
• Same-day surgery
• Durable medical equipment and prosthetic/orthotic devices
• Home health care services
• Hospice care
• Infertility services
• Organ transplants
• Nonemergency ambulance transport (Note: Routine transportation to and from medical care providers is not covered.)

Provider network

Medical management procedures

As a Fallon Preferred Care member, you’re not required to obtain referrals. However, preauthorization 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 preauthorization 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 preauthorization 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
• Organ transplants
• Nonemergency ambulance transport (Note: Routine transportation to and from medical care providers is not covered.)

Questions? Call us

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

1-888-468-1541 (TTY users please call TRS Relay 711)
Monday through Friday
8 a.m. to 6 p.m.
contactcustomerservice@fchp.org