Fallon Health

Horrific. We are small business owners and wanted an affordable health plan. We pay in excess of $ 800/​month and have been ok with past prescription coverage, co-​pays etc.
Well, wait until you need these people…
My husband was hospitalized for a mild heart attack and afib. A week later, I am denied surgery [that was already scheduled], even though my doctor and I agreed it a prudent measure. Appealed the decision, and still no success.
Additionally, my husband who suffers horrible sleep apnea and has used a machine for 20+ years, has not yet been approved [one month after heart attack and afib] for an updated sleep study… despite his constant calling [over 5 times+]
They do not care. They want premiums and no payouts… Sad, that this is what we are reduced to and that people are so afraid of socialized medicine when our money can only buy us «convenience centered care.»
Go to a casino and take your chances. Your odds are better!!!

The absolute worst insurance plan ever. I never write these things but I am absolutely outraged at way this company runs and treats subscribers. Its all about the bottom dollar. I had to change over to them because of my new employer and it has been a nightmare. I am diabetic and nearly all of my medications that I had previously been on and doing well were not covered — it took weeks to find out then when I was told that I needed letters of medical necessity for all of them. Once they got their letters from my doctor then it was another 2 – 3 weeks before I was told that I was denied! Huh? «Can they do this?» Apparently they can and did. Stay away and beware the worst excuse for a health plan. They are pretty much the joke of central MA with regards to healthcare plans but when your employer uses them you are stuck.

This is the first review I have ever written and I really hope it prevents people from using this company in the future. I never, never do this kind of thing.
When you hear about Health Insurance being a scam, and how they are trying to rip you off, etc., those people are talking about companies like Fallon. On MANY occasions, Fallon has lied to and misled my family and me. I couldn’t even list all the examples if I wanted to. I’ll give you two examples from THIS MONTH though just to give you a feel of what they’ll do to you.
Personally, I had a crippling back injury and was out of state. They sent me through three different doctors and the most complicated series of referrals ever, before sending me a letter saying they’d pay for the service. Now they refuse to pay my multi-​thousand dollar physical therapy bills, and EVERY time I call, the employees contradict each other. They record 99% of their calls, but they won’t let me listen to the records, and somehow they are unable to find the original conversations in which they told me I’d be covered. If it wasn’t so personal, I’d post the incredibly misleading (at best) letters they sent.
Recently they told my father he’d be covered if he went to get eye surgery at a specific doctor’s office. He called three times to check and check again (because Fallon lies, and we know this, so we have to ask multiple staff members to make sure we get the same answer). When he gets to the doctor’s office, the receptionist says «FALLON? No way are we taking them, they always say they’ll pay and then never do.» So my dad gets on the phone with fallon, who says that the receptionist is wrong and that they will definitely pay. FCHP and the receptionist talk to each other for about 45 minutes, then my dad gets back on the line and FCHP says «oh.she is right, we wouldn’t have paid.» So instead, they send him to the only eye doctor they actually cover, and my dad said the place was so sketchy he didn’t even when them working on his eye.
Again, those are just the two examples from the last few weeks. I have never written a bad review about anything, ever. But I honestly feel that someone needs to warn everyone about this company, and what they will do to you.
The most optimistic and nice thing I could force myself to say about them is that maybe they just have very very poorly trained staff members who offer contradicting and incorrect statements because that is what they believe to be true. However, from the misleading text of their letters and the fact that my phone calls couldn’t be located, I tend to think they are just not a very good company.
It blows my mind that the woman below me wrote such a nice review about the company, but that was two years ago, so maybe the company has changed.

Consistently the most attentive, friendly, and sincere customer service of any health insurance company I’ve ever dealt with. Fallon is an excellent company — for a moderate price, the prescriptions are reasonably-​priced, standard services are rendered without high deductibles, and their providers are consistently excellent.
I can’t recommend Fallon Community Health Plan (sadly, only in certain East Coast states), or their customer service highly enough!