UPDATES FROM FALLON HEALTH - February 2023

At Fallon Health, we focus on providing the best products and services to our members. We work to make sure they have the care they need, where and when they need it. It’s why we take the extra step and lend a hand however we can. We’re compassionate, responsive, respectful, and approachable in everything we do. Because at Fallon Health, we care.

This approach helps us provide exceptional customer service to our members. Our Customer Service team is the best around—literally! We were named Best Customer Service in Central Massachusetts by Worcester Telegram & Gazette readers. 

This recognition means the world to us. It shows that our members trust us and value what we do to help make their lives better. I’m sure your clients who renew their Fallon Health coverage every year would agree. 

On behalf of our Customer Service team, we look forward to supporting new Fallon Health members and continuing to assist those who renew their coverage. If you have any questions, please contact our Broker Relations team at 1-844-848-4931 (TRS 711), Monday–Friday, 8:30 a.m.–5:00 p.m., or send them an email at MedicareSalesBrokers@fallonhealth.org.

Sincerely,

Don Perron

Vice President of Customer Service

When Fallon Health members have an issue or concern, they know they can count on us to help them quickly and efficiently because everyone on our team knows their stuff. Nearly 90% of issues brought to our Customer Service team are resolved after just one call (or email).

Our customer service representatives are well-versed in all our products, and in how the health care system works. They’re proactive—if a member has a complex issue, they reach out to make sure the member’s needs are being met. They also keep an eye out for trends that may cause member abrasion, so that we can find resolutions quickly. It’s no wonder that Fallon Health’s member satisfaction rate has been at nearly 90% since 2015.

Episode 4 of our podcast, Improving Your Health with Fallon Health’s Richard Burke, talks about how people can better understand their health insurance coverage.

When the pandemic began in March 2020, MassHealth suspended redeterminations to ensure that everyone maintained health coverage during the health crisis. Redetermination is an annual process the state uses to determine if people who have MassHealth are eligible to keep their coverage. MassHealth will resume these redeterminations starting on April 1. Expectations are that these redeterminations will take place over a 12-month period and will then go back to business as usual on an annual basis.

Those who will need to complete paperwork for redetermination will be notified. Some may hear from MassHealth in the next month or two, others later in the year. It is likely that some of your clients who are enrolled in our NaviCare^® plans or in Fallon Health’s PACE (Program of All-Inclusive Care for the Elderly)—Summit ElderCare^®—will need to take part in this process. For Fallon Health members who may need help, we can help them find the right assistance.

Should any of your clients need to transition to different coverage, Fallon Health has other plans available. To learn more, please contact our Broker Relations team at 1-844-848-4931 (TRS 711), Monday–Friday, 8:30 a.m.–5:00 p.m., or by email at MedicareSalesBrokers@fallonhealth.org. 

Fallon Health has been covering—and will continue to cover—over-the-counter COVID-19 tests. We will cover the cost of the following:

• For NaviCare^® members—up to eight over-the-counter FDA-emergency use authorized tests per member per month without prior authorization.
• For Fallon Medicare Plus™ members whose plans include a pharmacy benefit—up to four over-the-counter FDA-emergency use authorized tests per member per month without prior authorization.

In addition to over-the-counter tests, Fallon Health covers diagnostic tests known as polymerase chain reaction (PCR) and antigen tests. These tests identify whether a person has an active COVID-19 infection. Fallon Health covers them at no cost-sharing for members as long as the member’s health care provider identifies that they’re symptomatic with COVID-19 related symptoms.

Contact us

Our easy-to-reach Broker Relations team is available to you at every stage of the sales process. We can provide you with personalized support over the phone Monday–Friday, 8:30 a.m.–5:00 p.m.

You can also reach us by email: MedicareSalesBrokers@fallonhealth.org

Check out our website

Especially our broker webpages. They're full of helpful information.

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