Peace of Mind Program™*

The Peace of Mind Program is a benefit available to Direct Care members that provides them with access to receive a second opinion and treatment for specialty services at one of five Boston hospitals:

How much is my copayment for seeing a Peace of Mind Program specialist?

For Direct Care members, your copayment is the same as your copayment for specialist office visits. 

Are there any eligibility requirements I have to meet in order to use my Peace of Mind Program benefit?

Yes. In order to use your Peace of Mind benefit, you must meet the following criteria: 

  1. You must be a Direct Care member.
  2. You must have seen the same type of specialist, in your network, for the same condition within the past three months. 
  3. The specialty services you are seeking must be covered services (see your Member Handbook/Evidence of Coverage for a listing of services covered with your plan). 
  4. Your PCP must request a prior authorization from Fallon Health for you to see a Peace of Mind Program specialist. Your PCP cannot deny you the right to request access to your Peace of Mind Program benefit.

Is there a limit to the number of times I can see a Peace of Mind Program specialist, or the services they can order?

As long as your PCP submits the appropriate referrals, you may continue to see your Peace of Mind Program specialist for up to one year or until treatment for your particular condition is complete--whichever comes first.

What if my PCP will not refer me to a Peace of Mind Program specialist, or it is taking too long to do so?

As long as you have met the eligibility requirements, you have the right to access your Peace of Mind Program benefit.

* 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.

Important information

Learning the terms

Tiers

Briefly stated, tiers are categories. For The Advantage Plan, we have categorized doctors and hospitals into two tiers.

You will have lower out-of-pocket costs when you receive care from a Tier 1 doctor or hospital.

Providers are only tiered for certain services, such as office visits, inpatient hospitalization and same-day surgery, through The Advantage Plan.