information iconInformation about
coronavirus (COVID-19) 

Overview

Updated December 31, 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, treatment and counseling with no cost-sharing for all members until further notice.
  • Waived cost-sharing for all COVID-19 related medically necessary telehealth services only for all members. This will also be effective until further notice.
  • Waiving early refill limits on non-scheduled control drug prescriptions for all Fallon members—with the exception of Berkshire Fallon Health Collaborative, Fallon 365 Care and Wellforce Care Plan members—who fill their medications, including specialty medications, at any in-network pharmacy. Some restrictions may apply*
  • 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

Fallon members will have no cost-sharing (deductibles, copays, coinsurance) for medically necessary COVID-19 testing, counseling and treatment. Fallon is also relaxing our prior authorization requirements for medically necessary COVID-19 related services until further notice.

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 is waiving cost-sharing for all COVID-19 related medically necessary telehealth services only for all members. This will also be effective until further notice.
  • 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.  Members of Berkshire Fallon Health Collaborative can call 1-877-219-0872; Fallon 365 Care members can call 1-877-219-0874; and Wellforce Care Plan members can call 1-877-219-0873. All other members can call 1-800-609-6175 (TDD/TTY: 1-800-848-0160).
  • Members can access physical therapy/occupational therapy/speech therapy (PT/OT/ST) services through both telephonic telehealth visits and video telehealth visits. Member cost sharing will be the same as an in-person visit.

Prescription medications 

Early refills

We are currently waiving early refill limits on drug prescriptions for all Fallon members—with the exception of Berkshire Fallon Health Collaborative, Fallon 365 Care and Wellforce Care Plan members—who fill their medications, including specialty medications, at any in-network pharmacy. Some restrictions may apply*.

You can also receive early refills for certain maintenance medication prescriptions up to a 90-day supply ahead of schedule. Your pharmacy simply needs to submit code 13 (SCC13) for coverage.

Home delivery

Some pharmacies are offering free home delivery of medications. Contact your pharmacy directly to learn more.

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. Many in-network physicians are conducting telehealth visits (doctor visits by phone or online) so you may not have to go into the office.
  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • Sore throat
  • New loss of taste or smell
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
  • Multisystem inflammatory syndrome (in children only).

    If you or a loved one begin to exhibit any of the following signs, seek emergency medical care immediately:
    trouble breathing, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, and/or bluish lips or face.

Preventing illness

You should:

  • Maintain good social distance (about 6 feet) from other people, and do not gather in groups.
  • 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.
  • Wear a cloth mask in public settings, like on public transportation, at events and gatherings and anywhere else you will be around other people. Make sure your mask covers your nose and mouth.
  • Stay home when you feel sick, and avoid contact with others who are ill.

Vaccines for COVID-19

Getting the vaccine

Massachusetts is preparing for the safe, equitable, and effective delivery of an FDA-approved COVID-19 vaccine. Vaccine distribution in Massachusetts will occur in a phased approach:

COVID-19 vaccine phases
Infographic: https://www.mass.gov/covid-19-vaccine-in-massachusetts, December 31, 2020

Currently there is no approved vaccine available for children under age 16, though clinical trials are starting for that age group. You should speak to your child’s pediatrician for guidance. For more information, visit https://www.mass.gov/info-details/when-can-i-get-the-covid-19-vaccine.

Vaccine safety

It’s important to know that vaccines go through more testing than any other pharmaceuticals. Before any vaccine is made available, it must go through rigorous development and testing. For more information regarding vaccine safety, visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/safety.html.

Coverage for COVID-19 vaccines

Once eligible to receive a vaccine based on the phased approach above, Fallon members will have no cost sharing if they choose to be vaccinated. Fallon also covers the flu shot vaccination in full and we recommend that all members receive the flu shot.

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. You will have no cost-sharing for medically necessary telehealth visits.
  • 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. Here are a few tips that you should keep in mind:

  • Do not respond to texts, emails, or calls requesting your personal information in exchange for a COVID-19 stimulus check. COVID-19 economic impact checks will be delivered based on 2018 or 2019 tax return information, so no action is required for most people.
  • Ignore offers for a COVID-19 cure or treatment. Remember, if there is a medical breakthrough, you won’t hear about it for the first time through an email, online ad, or unsolicited sales pitch.
  • If you receive a message about being eligible for a vaccine, look carefully. Ask yourself who is sending the message? Is it your PCP? Your pharmacy? The local Department of Public Health? Call the originating message sender, using a number you know to be theirs.
  • Research any charities or crowdfunding sites soliciting donations in connection with COVID-19 before giving. An organization may not be legitimate even if it uses words like “CDC” or “government” in its name.
  • Be cautious of purchasing personal protective equipment (PPE) from unknown third-party vendors. Verify that the company is legitimate before ordering their products or sending money.
  • Never click on a link or open an email attachment from an unknown or unverified source. Links and attachments may be embedded with a virus that will infect your computer or mobile device. To better protect yourself against malware, make sure your anti-virus software is operating and up-to-date.
  • 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

*Restrictions include:

  • For NaviCare/PACE Medicaid Only: early refills allowed on standard maintenance drugs, HIV, transplant, behavioral health, benzodiazepines, hypnotics and specialty drugs; and excludes controlled schedule II to V medication.
  • For commercial members only: early refills allowed on standard maintenance drugs, HIV, transplant and specialty drugs; and excludes controlled schedule II to V medication.
  • There are no exclusions for Fallon Medicare Plus Medicare Advantage members or NaviCare HMO-SNP members.

Si usted, o alguien a quien usted está ayudando, tiene preguntas acerca de Fallon Health, tiene derecho a obtener ayuda e información en su idioma sin costo alguno. Para hablar con un intérprete, llame al 1-800-868-5200.

Se você, ou alguém a quem você está ajudando, tem perguntas sobre o Fallon Health, você tem o direito de obter ajuda e informação em seu idioma e sem custos. Para falar com um intérprete, ligue para 1-800-868-5200.

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Call us toll-free at 1-888-340-5504 (TRS 711), 8 a.m.–8 p.m., seven days a week
(From Jan.–Sept., 8 a.m.–5 p.m., Mon.–Fri.)

H9001_210085_C | The information on this page was last updated on 10/1/2020.