What to do if you receive a bill

If you get a bill in the mail from a doctor’s office, lab, hospital or other health care provider, find out if you owe anything before you pay the bill. You can do this by looking at your Health Benefits Statement or checking your claims through our secure member section, myFallon:

  1. Log in to myFallon.
  2. Click on the “My claims” page.
  3. Find the claim that includes the services you are being billed for.
  4. Click on "Details" of the claim to see a break down of costs.
  5. If you don't see a claim related to your bill, call your provider. 

Why you would receive a bill

You might receive a bill from your provider if:

  1. The provider did not send us a bill.
  2. The provider is not in your plan's network or is not contracted with us.
  3. You are being billed for your portion of coinsurance, your deductible or your copayment.
  4. The bill may have been sent to you by mistake.

Copayments, coinsurance and deductibles

These amounts that you may be responsible for paying are listed in your Schedule of Benefits, on the "My benefits" page of myFallon.

To see if the bill might be for your copayment or coinsurance, or toward your deductible:

  • On myFallon, in the claim details, find the totals for the copayments, coinsurance and deductibles columns. These are your cost sharing amounts. 
  • If there are amounts listed, you are responsible for those costs.
  • If you have a deductible plan, check your most recent Health Benefits Statement to see if the amount on the bill matches the amount your statement says you're responsible for. Learn more about Health Benefits Statements » 
  • Confirm the amount on your bill with the amounts in the claim details, and send payment to the address on the bill.

If you have a health reimbursement account (HRA), contact the administrator of the account. An HRA will typically contribute to your cost sharing after you have paid a certain amount.

» Definitions of coinsurance, copayment, deductible and more health insurance terms 

A claim was denied

You may or may not owe anything if a claim is denied. Follow the directions in the claim details on myFallon, under the line item that was denied. In most cases, you will be asked to call our Customer Service Department.

Request reimbursement

If you paid for a bill for which you can get reimbursed, for example:

You may submit a Request reimbursement form to Fallon Health. 

More information

 

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Got questions?

We're here to help!

1-800-868-5200 
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cs@fallonhealth.org

We'll be happy to answer your questions!