Fallon Health provider networks

A network is a group of health care providers (like doctors, hospitals and other facilities) that are contracted with Fallon to provide covered services to members. Which provider network you have depends on which Fallon plan you're enrolled in. You can find the name of your provider network on your health plan ID card.

  • Overview
  • Direct Care
  • Select Care
  • Preferred Care
  • Tiered Choice
  • Steward
  • MassHealth

Network maps

Direct Care Select Care Tiered Choice Steward Community CareMassHealth network maps

Hospital list

Hospital name Direct Care Select Care Tiered Choice Steward Community Care MassHealth
Addison Gilbert Hospital, Gloucester
Anna Jaques Hospital, Newburyport
Athol Memorial Hospital, Athol Tier 3
Baystate Franklin Medical Center, Greenfield
Baystate Mary Lane Hospital, Ware
Baystate Medical Center, Springfield
Baystate Wing Hospital, Palmer Tier 1
Berkshire Medical Center, Pittsfield Tier 1
Beth Israel Deaconess Hospital-Milton
Beth Israel Deaconess Hospital-Needham
Beth Israel Deaconess Hospital-Plymouth
Beth Israel Deaconess Medical Center, Boston
Beverly Hospital, Beverly
Boston Medical Center, Boston
Brigham and Women's Faulkner Hospital, Boston
Brigham and Women's Hospital
Carney Hospital, Boston
Catholic Medical Center, Manchester, NH
Charlton Memorial Hospital, Fall River
Cheshire Medical Center, Keene, NH
Children’s Hospital, Boston
Clinton Hospital, Clinton Tier 1
Cooley Dickinson Hospital, Northampton Tier 3
Dana-Farber Cancer Institute, Boston
Elliot Hospital, Manchester, NH
Emerson Hospital, Concord
Exeter Hospital, Exeter, NH
Fairview Hospital, Great Barrington Tier 1
Good Samaritan Medical Center, Brockton
Harrington HealthCare at Hubbard, Webster Tier 2
Harrington Memorial Hospital—Southbridge Campus, Southbridge Tier 2
HealthAlliance Hospital, Fitchburg Tier 2
HealthAlliance Hospital, Leominster Tier 2
Heywood Hospital, Gardner Tier 1
Holy Family Hospital, Methuen
Holy Family Hospital at Merrimack Valley, Haverhill
Holyoke Medical Center, Holyoke Tier 1
Lahey Hospital and Medical Center, Burlington
Lawrence General Hospital, Lawrence
Lawrence Memorial Hospital, Medford
Lowell General Hospital, Main Campus
Lowell General Hospital, Saints Campus
Marlborough Hospital, Marlborough
Mary Hitchcock Memorial Hospital, Lebanon, NH
Massachusetts Eye & Ear Infirmary, Boston
Massachusetts General Hospital
Melrose-Wakefield Hospital, Melrose
Mercy Medical Center, Springfield Tier 1
MetroWest Medical Center, Framingham
MetroWest Medical Center, Natick
Milford Regional Medical Center, Milford
Morton Hospital, Taunton
Mount Auburn Hospital, Cambridge
Nashoba Valley Medical Center, Ayer Tier 1
New England Baptist Hospital, Boston
Newton-Wellesley Hospital, Newton
Noble Hospital, Westfield Tier 1
North Shore Medical Center—Salem Hospital, Salem
North Shore Medical Center—Union Hospital, Lynn
Norwood Hospital, Norwood
Parkland Medical Center, Derry, NH
Portsmouth Regional Hospital, Portsmouth, NH
Saint Anne’s Hospital, Fall River
Saint Elizabeth's Medical Center, Boston
Saint Luke’s Hospital, New Bedford
Saint Vincent Hospital, Worcester Tier 1
Signature Healthcare Brockton Hospital, Brockton
South Shore Hospital, Weymouth
Southern New Hampshire Medical Center, Nashua, NH
Southwestern Vermont Medical Center, Bennington, VT
Sturdy Memorial Hospital, Attleboro
Tobey Hospital, Wareham
Tufts Medical Center, Boston
UMass Memorial Medical Center—Memorial Campus, Worcester Tier 1
UMass Memorial Medical Center—University Campus, Worcester Tier 1
Winchester Hospital, Winchester

Peace of Mind Program™*

Direct Care members also have access to our Peace of Mind Program which allows you to get a second opinion and, if you choose, receive your care from a specialist at these renowned Boston medical centers:

Steward Community Care - specialty care

In some circumstances and with a prior authorization from the plan, members may receive medically necessary services that are not available at an Steward Community Care facility from either Brigham and Women’s Hospital or Massachusetts General Hospital.

This information was last reviewed on 6/22/16.

Direct Care network and service area

Map of Direct Care service area and network providers

Our Direct Care limited provider network is a high-performing and concentrated network of doctors and community-based hospitals. Because this network offers members more coordinated, cost-efficient care, it’s available at a lower premium than plans using the Select Care network.

Doctors, hospitals and medical centers

Find a doctor in the Direct Care network

  • Addison Gilbert Hospital
  • Athol Memorial Hospital
  • Beverly Hospital
  • Beth Israel Deaconess Hospital-Milton
  • Beth Israel Deaconess Hospital-Plymouth
  • Brigham & Women's Faulkner Hospital
  • Charlton Memorial Hospital
  • Clinton Hospital
  • Emerson Hospital
  • Harrington Memorial Hospitals
  • HealthAlliance Hospitals
  • Heywood Hospital
  • Lahey Hospital and Medical Center
  • Lawrence General Hospital
  • Lowell General Hospital
  • Marlborough Hospital
  • Massachusetts Eye & Ear Infirmary
  • MetroWest Medical Centers
  • Milford Regional Medical Center
  • Mount Auburn Hospital
  • New England Baptist Hospital
  • Newton-Wellesley Hospital
  • Saint Vincent Hospital
  • Signature Healthcare Brockton Hospital
  • South Shore Hospital
  • St. Luke’s Hospital
  • Tobey Hospital
  • Tufts Medical Center
  • Winchester Hospital

Direct Care includes:

  • Acton Medical Associates
  • Allied Pediatrics of Greater Brockton, Inc.*
  • Brockton Area Primary Care, LLC *
  • Cape Ann Medical Center
  • Cape Ann Pediatrics
  • Central Massachusetts Independent Physician Association, LLC
  • Charles River Medical Associates
  • Greater Lawrence Family Health Center
  • Harrington PHO
  • HealthCare South, P.C.*
  • HealthFirst Family Care Center (Fall River)
  • Highland Healthcare Associates IPA
  • Jordan Physician Associates
  • Lahey Clinic Physicians
  • Lawrence General IPA
  • Lowell General PHO
  • Mass Bay Medical Associates, LLC*
  • Metrowest Quality Care Alliance*
  • Milton Primary Care, LLC*
  • Mount Auburn Cambridge IPA
  • Northeast PHO
  • Newton-Wellesley Physician Hospital Organization
  • Pediatric Associates of Brockton, Inc.*
  • Pentucket Medical
  • Plymouth Bay Primary Care, LLC*
  • Primary Care Medical Associates, LLC*
  • Reliant Medical Group
  • Saint Vincent Medical Group
  • Signature Healthcare Bridgewater Goddard Park Medical Associates
  • Signature Healthcare Brockton Hospital and affiliated providers
  • South Shore PHO
  • Southboro Medical Group
  • Southcoast Physicians Network
  • Tufts Medical Center Physicians Organization, Inc.*
  • Woburn Pediatric Associates, LLC*

* A New England Quality Care Alliance group

Direct Care Peace of Mind ProgramTM facilities

  • Beth Israel Deaconess Hospital
  • Brigham and Women’s Hospital
  • Children's Hospital
  • Dana-Farber Cancer Institute
  • Massachusetts General Hospital

Coverage outside the network

Fallon members are covered for emergency care worldwide. However, if you're away from home, you may have the unexpected need to receive non-emergency services. That's where Healthy Directions can help – it connects you with a network of more than 600,000 physicians and health care facilities across the country. Plan authorization is required for out-of-area non-emergency care.

How can I find a Healthy Directions provider?

  • Call 1-800-354-7507
    OR
  • Search online.
    (You’ll be asked to identify your network before you search. Select “PHCS Healthy Directions,” then click “Continue.”)

This information was last reviewed on 6/22/16.

Select Care network and service area

Map of Select Care service area and network providers

Our Select Care network is an extensive HMO network of more than 40,000 doctors and facilities located throughout Massachusetts, Southern New Hampshire and Southern Vermont.

Doctors, hospitals and medical centers

Find a doctor in the Select Care network

The Select Care network includes all the doctors and facilities in the Direct Care limited provider network plus:

  • Baystate Health System
  • Berkshire Medical Group
  • Hawthorn Medical Associates
  • Harvard Vanguard Medical Associates
  • New Bedford Medical Associates
  • Newton-Wellesley Physician Hospital Organization
  • Pittsfield Medical Associates
  • South Shore Medical Center
  • Southcoast Physician Services
  • Southwestern Vermont PHO
  • Williamstown Medical Associates
  • and MORE

Hospitals

Addison Gilbert Hospital
Anna Jaques Hospital
Athol Memorial Hospital
Baystate Franklin Medical Center
Baystate Mary Lane Hospital
Baystate Medical Center
Baystate Wing Hospital
Berkshire Medical Center
Beth Israel Deaconess Hospital-Milton
Beth Israel Deaconess Hospital-Needham
Beth Israel Deaconess Hospital-Plymouth
Beth Israel Deaconess Medical Center
Boston Medical Center
Brigham & Women's Faulkner Hospital
Brigham & Women's Hospital
Beverly Hospital
Carney Hospital
Charlton Memorial Hospital
Children’s Hospital
Clinton Hospital
Cooley Dickinson Hospital
Dana-Farber Cancer Institute
Emerson Hospital
Fairview Hospital
Good Samaritan Medical Center
Harrington Memorial Hospitals
HealthAlliance Hospitals
Heywood Hospital
Holy Family Hospital
Holyoke Medical Center
Lahey Hospital and Medical Center
Lawrence General Hospital
Lawrence Memorial Hospital
Lowell General Hospital, Main Campus
Lowell General Hospital, Saints Campus
Marlborough Hospital
Massachusetts Eye & Ear Infirmary, Boston
Massachusetts General Hospital
Melrose-Wakefield Hospital
Mercy Medical Center
Merrimack Valley Hospital
MetroWest Medical Centers
Milford Regional Medical Center
Morton Hospital and Medical Center
Mount Auburn Hospital
Nashoba Valley Medical Center
New England Baptist Hospital
Newton-Wellesley Hospital
Noble Hospital
North Shore Medical Center—Salem Hospital
North Shore Medical Center—Union Hospital
Norwood Hospital
Saint Anne's Hospital
Saint Vincent Hospital
Signature Healthcare Brockton Hospital
South Shore Hospital
St. Luke's Hospital
Sturdy Memorial Hospital
Tobey Hospital
Tufts Medical Center
UMass Memorial Medical Center—
Memorial Campus
UMass Memorial Medical Center—
University Campus
Winchester Hospital

New Hampshire

Catholic Medical Center
Cheshire Medical Center
Elliot Hospital
Exeter Hospital
Mary Hitchcock Memorial Hospital
Parkland Medical Center
Portsmouth Regional Hospital
Southern New Hampshire Medical Center

Vermont

Southwestern Vermont Medical Center

Coverage outside the network

Fallon members are covered for emergency care worldwide. However, if you're away from home, you may have the unexpected need to receive non-emergency services. That's where Healthy Directions can help – it connects you with a network of more than 600,000 physicians and health care facilities across the country. Plan authorization is required for out-of-area non-emergency care.

How can I find a Healthy Directions provider?

  • Call 1-800-354-7507
    OR
  • Search online.
    (You’ll be asked to identify your network before you search. Select “PHCS Healthy Directions,” then click “Continue.”)

This information was last reviewed on 6/22/16.

Preferred Care network

Map of the Preferred Care network service area which includes the entire United States

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

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.)

    Medical management procedures

    As a 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.)

    Tiered Choice network and service area

    Map of Tiered Choice service area and network providers

    Tiered Choice is a 3-tier network plan, and includes three plan design options. Tiered Choice is currently available in Berkshire, Hampden, Hampshire and Worcester counties, and will continue to expand throughout Massachusetts.

    How does tiering work?

    Tiering for tiered network plans is defined as assigning providers to different levels—or tiers—based on certain criteria. With Tiered Choice, providers are tiered based on total medical cost. Those providers who manage total medical cost the best are in Tier 1. When you see a Tier 1 provider, you pay a lower cost-sharing amount than you would pay if you see a Tier 2 or a Tier 3 provider.

    In all three of our plan designs, we tier hospitals, free-standing outpatient facilities and high-tech imaging. And in two of our plan designs we tier PCPs and specialists.

    Doctors, hospitals and medical centers

    Hospital

    Tier

    Athol Memorial Hospital

    3

    Baystate Wing Hospital

    1

    Berkshire Medical Center

    1

    Clinton Hospital

    1

    Cooley Dickinson Hospital

    3

    Fairview Hospital

    1

    Harrington HealthCare at Hubbard

    2

    Harrington Memorial Hospital

    2

    Health Alliance Hospitals

    2

    Henry Heywood Hospital

    1

    Holyoke Medical Center

    1

    Mercy Medical Center

    1

    Nashoba Valley Medical Center

    1

    Noble Hospital

    1

    Saint Vincent Hospital

    1

    UMass Memorial Medical Centers

    1

    Fallon Tiered Choice provides access to a network that is smaller than the Select Care provider network, and includes the tiered provider network called Tiered Choice. In this plan, members have access to network benefits only from the providers in Fallon Tiered Choice, and may pay different levels of copayments, coinsurance and/or deductibles depending on the tier of the provider delivering a covered service or supply. This plan may make changes to a provider’s benefit tier annually on January 1. Please consult the Find a Doctor tool to determine which providers are included in Tiered Choice.

    Steward Community Care network and service area

    Steward Community Care network and service area map

    Fallon has partnered with Steward Health Care System to develop a new limited network plan designed to help you save on health care costs, while still receiving the highest level of care. The Steward Community Care network includes all of the Steward Health Care system community doctors and hospitals.

    Doctors, hospitals and medical centers

    Find a doctor in the Steward Community Care network

    • Carney Hospital
    • Good Samaritan Medical Center
    • Holy Family Hospital
    • Holy Family Hospital at Merrimack Valley
    • Morton Hospital and Medical Center
    • Nashoba Valley Medical Center
    • New England Sinai Hospital
    • Norwood Hospital
    • Saint Anne’s Hospital
    • St. Elizabeth’s Medical Center

    In some circumstances and with a prior authorization from the plan, members may receive medically necessary services that are not available at a Steward Community Care facility from either Brigham and Women’s Hospital or Massachusetts General Hospital.

    This information was last reviewed on 6/22/16.

    Fallon MassHealth network

    Map of the Fallon network service area

    As a Fallon MassHealth member, you have access to top providers near where you live and work.

    Doctors, hospitals and medical centers

    Find a doctor in the Fallon MassHealth network

    • Addison Gilbert Hospital
    • Athol Memorial Hospital
    • Beverly Hospital
    • Clinton Hospital
    • Edward M. Kennedy Community Health Center
    • Harrington Memorial Hospital
    • HealthAlliance Hospital, Fitchburg
    • HealthAlliance Hospital, Leominster
    • Heywood Hospital
    • Lahey Health
    • Lawrence General Hospital
    • Lowell Community Health Center
    • Marlborough Hospital
    • Metrowest Medical Center, Framingham
    • Metrowest Medical Center, Natick
    • Milford Regional Medical Center
    • Reliant Medical Group (formerly known as Fallon Clinic)
    • Saint Vincent Hospital
    • UMass Memorial Medical Center - Memorial Campus
    • UMass Memorial Medical Center - University Campus

    * The Peace of Mind Program™ is available to Direct Care members only. It is not available for patients enrolled in Select Care, Fallon MassHealth, Steward Community Care, Tiered Choice, Preferred Care, or Fallon Senior Plan™. The Peace of Mind Program may be used for all specialty care except infertility services, mental health, substance abuse, chiropractic services, dental care, or speech therapy. Patients may not use the Peace of Mind Program for any primary care services, including internal medicine, family practice, pediatrics or obstetrics.

    The information contained on this page is current as of October 2014. We encourage you to check for the most updated provider information by calling our Customer Service Department.

    Direct Care is a plan with a limited provider network. This plan provides access to a network that is smaller than Select Care. In this plan, members have access to network benefits only from the providers in Direct Care. Please visit our Find a Doctor tool or consult the Direct Care provider directory to determine which providers are included in Direct Care. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.

    Steward Community Care provides access to a network that is smaller than the Select Care provider network. In this plan, members have access to network benefits only from the providers in Steward Community Care. Please visit our Find a Doctor tool or consult the Steward Community Care provider directory to determine which providers are included in Steward Community Care. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.

    Tiered Choice provides access to a network that is smaller than the Select Care provider network, and includes the tiered provider network called Tiered Choice. In this plan, members have access to network benefits only from the providers in =Tiered Choice, and may pay different levels of copayments, coinsurance and/or deductibles depending on the tier of the provider delivering a covered service or supply. This plan may make changes to a provider’s benefit tier annually on January 1. Please visit our Find a Doctor tool or consult the Tiered Choice provider directory to determine which providers are included in Tiered Choice. A paper copy can be requested by calling our Customer Service Department at 1-800-868-5200.

    See our other networks