Fallon Community Health Plan Insurance Review & Ratings (2024)

Fallon Community Health Plan

Founded in Massachusetts in 1977, Fallon Community Health Plan quickly became qualified as one of the state’s first federal Health Maintenance Organizations (HMOs). In 1980, FCHP became one of the first HMO health insurance plans in the nation to receive a special Medicare contract from the U.S. Health Care Financing Administration (HCFA). This contract has helped position Fallon Community Health Plan as a top health care option for seniors.

FCHP has also been accredited by the National Committee for Quality Assurance (NCQA) and has been recognized as one of the country’s leading HMOs. Fallon provides Medicare Advantage, Medicare Supplement, and several comprehensive care programs with a focus on senior healthcare.

Since 2009, Fallon Community Health Plan has offered coverage in New Hampshire, and a 2014 partnership has led to expansion into New York state. While continuing to use the FCHP abbreviation known to its customers, Fallon Community Health Plan has embraced a larger clientele base by simply changing its official name to Fallon Health.

A visit to the FCHP website will yield the Fallon Community Health Plan provider phone number, physical address, and hours of operation. From there, you can explore all of the healthcare options that Fallon Health has to offer.

Fallon Community Health Plan Is a Part of MassHealth

MassHealth is a program that combines the Medicaid and Children’s Health Insurance Program (CHIP). In Massachusetts, MassHealth members can acquire coverage for hospital stays, doctor visits, prescription drugs, and many other services.

With participation in MassHealth, enrollees are able to select a primary care provider (PCP) and a health plan for each family member. A health plan is the group of participating doctors, hospitals, and health care providers that work together to provide the healthcare you need. And Fallon Health is one such health plan.

NaviCare is the Fallon Community Health Plan program that services patients who qualify for both Medicare and MassHealth Standard. If you are 65 or older, live in the service area, and are eligible for Medicaid, you can qualify for MassHealth. This feature allows you to take advantage of numerous benefits beyond what you normally receive from either Medicare or Medicaid alone.

Fallon Health Medicare Plans

Fallon Health offers several options for expanding your Original Medicare coverage. With Medicare Advantage, you can replace your Medicare Part A and Part B coverage with a plan that includes prescription drug coverage.

Fallon Medicare Plus Central plans offer distinct coverage options under the labels Orange, Green, and Blue. Each has unique features and differing costs for premiums, co-pays, and deductibles. All of these plans include Medicare Part D prescription drug coverage.

Fallon Community Health Plan also features two standard Medicare Supplement plans. The Core Plan covers limited blood transfusions, most coinsurance amounts, and emergency travel for medical expenses. FCHP also offers the Fallon Medicare Plus Supplement 1A Plan which handles most out-of-pocket expenses not covered by Original Medicare.

Summit ElderCare is a Fallon Health program that caters to seniors who still live at home but require assistance with daily tasks, at-home care, and medication.

Fallon Community Care Plan

In addition to Medicare-related coverage for seniors, Fallon Community Health Plan insurance also offers coverage for individuals, families, and businesses. With the Fallon Health Community Care Plan, enrollees can receive low monthly premiums, co-payments, and cost sharing for prescription drugs.

In addition, the FCHP Community Care Plan offers extra benefits geared toward healthy lifestyles and community involvement. Activities like gym memberships, fitness classes, and subscriptions to health education and smoking cessation programs can help lower your healthcare expenses.

Telehealth services are also featured to provide options for those wishing to avoid unnecessary exposure. Participating doctors nationwide can diagnose and treat dozens of common illnesses via phone, mobile device, or online interaction.

A subset of the Fallon Community Care Plan provides coverage for small businesses. If your business employs less than 50 people, you can purchase a Community Care plan to cover your employees and their families. Depending on your business size, you can either enroll directly through FCHP or visit the Massachusetts Health Connector to sign up.

Fallon Community Health Plan Direct Care Network

You can access the Fallon Health Direct Care networkfrom the official government website of Massachusetts. FCHP features two types of networks with different levels of benefits for your health care needs.

Select Care is a large, tiered network of providers with over 60,000 participants throughout Massachusetts and New Hampshire. This network provides access to a larger group of medical professionals, but you will face higher premiums.

Fallon Community Direct Care network includes fewer providers and is limited to Massachusetts. This concentrated network of doctors and hospitals is focused on the needs of the local community. Fallon Health’s Direct Care network offers cost-efficient care with a lower premium than the Select Care network.

Navigating Fallon Community Health Plan Insurance Claims Process

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

Filing a claim with Fallon Community Health Plan Insurance is a straightforward process designed to minimize hassle for policyholders. As an HMO (Health Maintenance Organization), most claims are typically handled internally without the need for policyholders to interact directly with the insurer.

Fallon Community Health Plan Insurance bills the insurance provider directly, simplifying the claims process. Policyholders usually only need to be concerned about the claims process if they have used an out-of-network provider in an emergency situation.

Average Claim Processing Time

Fallon Community Health Plan Insurance aims to provide efficient claim processing to ensure that policyholders receive timely reimbursements and benefits. While specific processing times may vary depending on the nature of the claim and other factors, the organization strives to minimize delays in handling claims.

Policyholders can typically expect a reasonably prompt resolution to their claims, allowing them to access the healthcare services they need without undue delay.

Customer Feedback on Claim Resolutions and Payouts

Customer feedback is a valuable indicator of an insurer’s performance in handling claims. Fallon Community Health Plan Insurance has received positive feedback from its policyholders regarding the resolution of claims and the payout process.

With few complaints filed and most complaints addressed and closed, the insurer has maintained a good reputation for transparent business practices and quality service. Fallon Community Health Plan’s commitment to addressing customer concerns contributes to its positive image in the industry.

Unveiling Fallon Community Health Plan Insurance Digital and Technological Advancements

Mobile App Features and Functionality

Fallon Community Health Plan Insurance offers a mobile app that provides policyholders with convenient access to their insurance information and healthcare resources.

The app includes features such as the ability to view policy details, access digital ID cards, check coverage, find in-network providers, and even use telehealth services when necessary. The mobile app enhances the overall customer experience by putting important information and tools at policyholders’ fingertips.

Online Account Management Capabilities

Policyholders of Fallon Community Health Plan Insurance can manage their accounts conveniently through the insurer’s online platform. The online account management system allows users to access and update their personal information, review claims history, check policy benefits, and make premium payments securely.

This digital convenience ensures that policyholders have easy access to their insurance information and can make necessary changes or updates with minimal effort.

Digital Tools and Resources

Fallon Community Health Plan Insurance provides a range of digital tools and resources to support policyholders in their healthcare journey. These resources include health education materials, wellness programs, and online resources related to preventive care and chronic condition management.

Additionally, telehealth services are available through digital channels, enabling policyholders to consult with healthcare providers remotely when needed. These digital tools and resources contribute to an improved overall healthcare experience for Fallon Community Health Plan Insurance policyholders.

Fallon Community Health Plan Insurance Reviews

With few complaints filed and closed within the last three years, FCHP has achieved an A- rating with the Better Business Bureau (BBB). There are almost no complaints filed to which Fallon Health has not responded.

The National Committee for Quality Assurance (NCQA) gives Fallon Community Health Plan a rating of 4.5 out of 5. This comprehensive review places FCHP among the nation’s best. FCHP scores high in several treatment areas, but it does have room for improvement in regard to consumer satisfaction.

Fallon Community Health Plan’s Medicare Advantage plans also received an overall rating of 4.5 out of 5 from the Centers for Medicare and Medicaid Services (CMS).

For a regional company, Fallon Community Health Plan has a relatively low number of reviews on Yelp. Fallon Health’s overall rating is two stars, indicating several negative complaints, but the sample size is fairly small.

Relative to pricing, Fallon Community Health Plan is a regional provider that tends to be priced higher than nationwide corporations. While FCHP does offer Medicare plans with low premiums and decent benefits packages, the co-pays and deductibles can be expensive. These prices tend to be higher than the average supplemental insurance costs for Medicare.

Fallon Community Health Plan: The Bottom Line

Fallon Health is known in the industry to have a good reputation for transparent business practices and quality service. With plans and programs that prioritize the needs of the local community, FCHP provides residents with care focused on their individual circumstances. FCHP does feature low premiums, but with higher prices for co-pays and deductibles.

If you don’t mind paying a bit more for a health plan from a local provider with a solid reputation, you may want to consider Fallon Community Health Plan.