Information about coronavirus (COVID-19)

Overview

Updated April 6, 2020

Fallon Health is monitoring public health developments and guidance regarding COVID-19.

The safety and well-being of our members is a top priority for Fallon Health, so we've worked to remove barriers and improve access to health care services for our members who may be impacted by COVID-19.

Fallon has implemented the following:

  • Relaxed prior authorization requirements generally in compliance with regulatory bulletins. These bulletins also specifically state that there can be no prior authorization requirements on any telehealth services delivered that are related to COVID-19
  • Coverage of medically necessary coronavirus testing and counseling (including telehealth) for members who meet DPH and CDC guidelines. Fallon members (including members of commercial, Medicare and Medicaid plans) will have no cost-sharing for medically necessary COVID-19 testing and counseling.
  • Waiving of copayments for medically appropriate coronavirus treatment in accordance with the CDC and DPH guidelines. Also, Fallon members who have telehealth benefits will have no copayments for telehealth services.
  • Waiving early refill limits on non-scheduled control drug prescriptions for all Fallon members who fill their maintenance medications at any in-network pharmacy. Members can now receive early refills for certain medications up to a 90-day supply of maintenance medication prescriptions ahead of schedule.
  • A dedicated hotline (1-877-835-8440, TRS 711) to connect members with representatives who can address questions about the coronavirus, discuss available benefits and provide phone numbers for additional help.

Fallon Health is open for business

As a state-designated essential business, Fallon Health is operating under our normal business hours. We are here to answer your questions and assist you in every way we can, especially during this critical time. However, our physical business offices are closed to visitors. If you need assistance, please call us or log into our online tools.

Coverage for care related to COVID-19

Fallon members will have no cost-sharing for medically necessary COVID-19 testing and counseling at in-network doctors’ offices, urgent care centers and emergency rooms. Fallon will also cover medically necessary COVID-19 treatment at in-network doctors’ offices, urgent care centers and emergency rooms in accordance with guidelines from the CDC and the Massachusetts Department of Health. Fallon members will pay no copayments for treatment, and we've removed all prior authorization requirements for medically necessary treatment of COVID-19.

Telehealth services

  • Fallon members can access telehealth services from all network providers who are offering these services. To schedule a telehealth visit, you can contact your provider at the same phone number you would use to request an in-office visit.
  • Fallon members who have the Teladoc benefit can also use that service.
  • Fallon will waive all member cost-sharing for COVID-19-related medically necessary telehealth services while Massachusetts is under a state of emergency.
  • Additionally, Fallon will waive cost sharing for all non-COVID-19-related medically necessary telehealth services for all members. 
  • Members who have the NurseConnect (our 24/7 nurse call line) benefit can also use this channel to receive medical services or advice at no cost to the member.

Prescription medications 

We are waiving early refill limits on non-scheduled control drug prescriptions for all Fallon members who fill their maintenance medications at any in-network pharmacy. Members can now receive early refills for certain medications up to a 90-day supply of maintenance medication prescriptions ahead of schedule. Additionally, certain pharmacies may offer free home delivery of your medications. Please speak to your pharmacy if you require additional supplies or would like to inquire about home delivery services.

What to do if you have symptoms

  • Check your symptoms with Buoy, a free online tool available to all Massachusetts residents.
    You can use Buoy to check your symptoms, figure out if you should be tested for coronavirus, and learn about care options available to you. Any information you provide on the Buoy tool is 100% secure, and will not be shared with anyone.

  • If you have any of the symptoms below, you should contact your primary care provider. Or, you can use telehealth services (access to doctors and nurses by phone or online). It's not recommended that you go directly to urgent care or an emergency room unless advised by a doctor or other provider.
  • Runny or stuffy nose
  • Sore throat or cough
  • Headaches or body aches
  • Shortness of breath
  • Fever

Preventing illness

You should:

  • Wash hands often with soap and warm water for at least 20 seconds.
  • Cover coughs and sneezes with your elbow or with tissues (not with your hand).
  • Avoid touching your face and have tissues available.
  • To help stop the spread of COVID-19, you should stay home. If you must go out, avoid crowds and practice social distancing. The CDC also recommends that you wear a cloth face covering if you have to be out in public.

Maintaining emotional health and well-being

Taking care of your emotional health and well-being during this time is important. Decreasing stress can help bolster your immune system and can help keep you and others around you healthy.

  • During this time of social distancing, consider creative ways to fight isolation and loneliness which can worsen some mental health symptoms.
  • There's a lot of information being shared about COVID-19. Not all of it is accurate and the bombardment of news and updates can add to an already stressful situation. To stay informed, but not overwhelmed, bookmark the websites in the "For more information" section below.
  • If you need mental health support
  • Contact your behavioral health provider to see if they can schedule a telehealth visit. Telehealth is a virtual therapy session. Many providers are now offering this option.
  • Contact SAMHSA's Disaster Distress Helpline. The Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters. Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.
  • Contact the Massachusetts Emergency Services Program/Mobile Crisis Intervention (ESP/MCI) - 1-877-382-1609.
  • If you have behavioral health benefits through Fallon Health, you can call the Beacon Health Options phone number on the back of your Fallon ID card to find a behavioral health provider and schedule a telehealth visit. You can also visit the Beacon Health Options website for more information.

You can find additional information and resources at https://www.mass.gov/info-details/maintaining-emotional-health-well-being-during-the-covid-19-outbreak.

Be aware of scams

Unfortunately, during this time, there is a greater risk of people trying to run scams. Legitimate insurance companies, like Fallon Health, are not selling supplemental insurance coverage related to COVID-19 at an additional cost. Please be sure to contact our Customer Service department if you receive any solicitation offering you the option to purchase any additional insurance policies or change the terms of your current coverage.

For more information