This is a review of my experience with a Fallon Health Medicare Advantage plan in 2024 and 2025. THEIR CUSTOMER SERVICE IS OUTSTANDING. I believe it's all based in MA. It counts as a social interaction! I've had Medicare Advantage plans from Aetna, Harvard and Tufts. If no one is waiting in the queue (rare) you can stay on the line and relax. The reps are human and relaxed in their home. Alas for 2026 they discontinued OTC and gym benefits for my plan. I was shocked when the rep says she makes it a point to tell people this - I had asked if she was getting a lot of calls about it. Another time I called to wonder why a prescription I had in the past had a jump in cost and the rep recommended GoodRx and looked up the GoodRX price while we were on the phone. read more

I have Fallon Navicare Whole Health, I've called many times for help & all of the customer care team are very kind & helpful for what ever my health needs are! Thank you Fallon Navicare! read more

horrible horrible horrible service they cancelled my plan when I was 2 days late I called to get it reinstated I had to pay a fixed right of 139 which was fine I called again and they said I had to pay that again which they never said fine I paid i called for a list of providers and they said yes they will send it over never got it I called again they said they will send it over never got it I called again turns out the email was wrong fixed it she said I will receive it in the next 24 hours never got it I called again and left they said they don't send out list of providers and my policy has been cancelled I never called to request a cancellation of my policy and they claim I did then they said they will issue a refund in 7-14 days ... in check through mail I'm super stressed now with no health insurance because they are incompetent please don't use this health insurance read more

This is the WORST of the WORST insurances. They assign you a case manager who NEVER follows up. They knew about formula and claimed that they had a DME to cover it. They didn't. They wouldn't reimburse the cost of the formula that was spent out of pocket for absolutely no reason aside from them being lazy and useless. Steer clear. You are just a money sign to them. This insurance doesn't care about your well being. Period.​​ read more

My visiting nurse was extremely unprofessional, very late for each visit, and overall careless with my father. She spent about 20 minutes in my bathroom which I found to be unprofessional, as she was doing a care visit for my dad. Once the nurse (I believe her name was Kendra Sear) left, half of my fathers medications were missing from his dispenser... Be careful with which nurse you get... I truly don't know how this woman works in the healthcare industry, she seemed like she was under the influence of some type of a downer. read more

I am a provider, not a patient. This is by far the worst insurance company to work with. Unresponsive, irresponsible, extremely low reimbursement rates and getting paid is about as likely as surviving a shark attack. After dealing with denied claims for almost a year, I reached out to the upper management. If they don't help me I'll file a complaint with the Massachusetts Insurance Commissioner. BBB will hear from me as well. ABSOLUTELY RIDICULOUS!!! The only reason I don't leave their network is because I feel bad for the patients. They need care and the list of providers, who accept Fallon, keeps getting shorter and shorter, and I definitely understand why. Sad, but true... read more

Fallon Health denied coverage for prostate issues simply because I'm over 80. So I'm forced to take a drug instead that exhausts me. So, I can't exercise, my weight's going up, and my general health is getting worse as a result. I guess they want me to die. read more

Signed up with work and the experience this year has been terrible. They don't help you find providers. I had to call office after office to find a general practitioner that was in network and taking new patients. After I finally got to see a GP, I got a referral from them to see a specialist only to find out later (after multiple visits to the specialist) that the specialist wasn't in network. I'd have saved myself and my employer a lot of money just paying everything out of pocket (which I ended up mostly having to do anyway). Fallon doesn't pay for healthcare, it doesn't provide healthcare, it doesn't even provide useful information on how to receive healthcare, it is just a pointless intermediary for insurance premiums that adds no value. read more

I was changed to Fallon and I told the girl that I didn't want to change. Well she did it anyway and screwed me up with doctors and prescriptions. Now getting back to my own insurance United its a pain in my ass. Don't give anyone your info unless you are sure you want to change!! read more

I made the mistake of enrolling with Fallon Medicare Plus HMO with a MasterCard Benefit Bank Card . This card is supposed to be used for dental, hearing aids, eyewear and fitness membership. So far this card has denied payment to the a local optical shop, the Franklin County dental clinic, and the YMCA. Fallon blames this on "improper coding" by the provider. It's all the provider's fault, Fallon is "working on this" by entering every provider denied as an "exception". I was told repeatedly that they "understood my frustration". I'm really not interested in their understanding; I'd like the Benefit Card to be good for something. I suppose I'm stuck with Fallon for this year, but I won't be back in 2022. read more

I have never been more disappointed in a company than I have been with Fallon Health. My husband and I have been struggling with infertility and despite Massachusetts requiring insurance companies to provide coverage, this company has made an already painful experience that much more painful. Throughout the entire process, they made us jump through hoops for medications, authorizations, which I had no problems with as I took it as part of the process. However, after suffering from two miscarriages and the horrible experience with my clinic, I sought other opinions. Due to distance (Boston) and reviews of doctors in the Worcester area, I was able to find a doctor but he was out of network(HMO), but did have a contract with Fallon's PPO plan. I requested to see this doctor, but was denied due to out of network policy. Now before I requested to see this doctor, I called Fallon's customer service and specifically asked them if this would be possible, as well as what the process was to get it approved. They told me that all I needed was a prior authorization, and that I would be all set. So their customer service reps are poorly trained as well. I appealed the denial decision, supporting my request to with medical records from my doctors and therapist, my own letter in support of our case, and they still denied us due to my policy plan and that it would be too expensive for them to cover future treatments(essentially they would approve the initial visit, but then deny coverage after that). They then sent us a list of in-network doctors that were not specialists for our diagnosis. Filing a grievance against them is useless, as that department only tries to fix the problem, but never works to address the issue for which the grievance was for. They claim they can only work within the limitations of my plan, or switch to a PPO, which means finding a new job. These limitations were placed by Fallon, and what is the point of having an appeals process if they have no intention of actually reviewing the appeals and reasons in support of seeking quality care. Do not trust your care with this insurance company, as they are only concerned with the bottom line, and not about incorporating more network doctors and the quality of care for their members. I will be switching to another health insurance, and had to get supplemental insurance due to Fallon. If I could give negative stars, I would. read more

Worst insurance I have had in 70+ years. Had to double, triple check before any procedures. Still they didn't pay. Saved emails as proof that certain services were covered, assured repeatedly by them it would be taken care of -- all LIES. Still trying to resolve a demand notice I just received today for over a year ago. Do yourself a favor, change like I did, the difference is unbelievable, prompt courteous help from competing insurance company. Wish I had dumped them long ago, or never made the mistake of signing with them. Please be warned, do not make the same mistake, it really isn't worth it and life is too short to deal with these idiots. read more

Just horrible health insurance. Will not pay for literally anything. I wish I could give them no stars.

Luckily, I have great health insurance now. But, the first one I ever bought for myself is Fallon. The thing I remember most about them is how difficult it was to get them to actually pay for anything, and I always got referrals. Eventually, all of the doctors I was seeing dropped Fallon, as did my employer as one of its options. They all said it was just too much of a hassle to get them to ever pay for anything. Granted it's been years since I had this insurance, but it doesn't look like it's gotten any better. I'd stay away from them at all costs unless you enjoy adding lots of extra stress in your life. read more

Fallon is the WORSE!!! Been waiting a month for preauthorization for my knee no one knows why it's taking too long and when I call I just get transferred till I'm disconnected If I could rate 0 i would read more

As an IT Contractor, I generally carry my own insurance. Here are my pros and cons about Fallon Health: PROS: 1) Easy initial sign-up online through eHealthInsurance.com. CONS: 1) No electronic payment option for the monthly premiums: I have been mailing the checks out using snail mail. Yes, in this day and age. How did I miss this? I would never have signed up otherwise. I did search for and find an ePay service out there from a 3rd party. But I did not see a formal endorsement to that service from either the eHealthInsurance.com or Fallon Health website. 2) Poor internal housekeeping: I changed my plan last December through eHealthInsurance.com because the premium went up by more than $100 on my old plan. Well, that site has been showing two active carrier approved plans since then. I spoke twice to reps at Fallon Health, once in January and once early this month, and was told that they will coordinate with eHealthInsurance.com and I will be receiving a bill for the new plan the same month. I just received the latest bill.. for the old plan.. yes, two months after the plan change. With this kind of internal mess at their business, can you imagine the kind of issues you are going to be running into with these people once you do have to make a claim? I will be starting to shop elsewhere for a health plan this month. read more

I just read all of previous reviews. Only two are positive, but they are very suspicious as no fact mentioned at all. All other reviews are negative with specific facts. The followings are two of my recent experiences. Last November I notified FH in written that I would be out of the country next three months, unable to access post office mails, and requested FH using email to communicate to me. This notice was completely ignored. When returned I found two months ago FH rejected my reimbursement request through a regular mail only. I immediately filed an appeal with detailed late filing reasons (just three days out of 60-day timeframe and the regulation allows late filing if have a proper reason). FH completely ignored my late filing reasons. I also filed a related grievance, it was completely ignored too, even no confirmation of receipt of the grievance. These ignores/neglects construct a perfect loop, caused customers no way to bring up concerns and grievances. My insurance is with one of Fallon Health Medicare Advantage Plans. The coverage documents contain many dim and vague languages. For caution purpose, last month I inquired the customer service via email: "I just had an annual wellness visit and my doctor let me go to Quest Lab to take a helicobacter pylori test. Is the test (CPT code 83013) covered by my insurance or need a prior authorization?" The lab test is common and inexpensive (about $100). This is a simple "Yes" or "No" question. But forth and back several times, the rep couldn't answer such a simple inquiry, instead, unreasonably insisting that I should ask my doctor to call Fallon Health Provider Service number. It is an insurance coverage question, of course, my doctor refused to make such a call, because the rep shifted her duty of answering my inquiry to the doctor with no reason. Just forget Fallon Health Customer Service, you will get no help but frustrates. Also see below the comments posted by a former Fallon Health call center employee on 6/1/2017 for additional information. read more

I've been a Fallon member for ten years or so, and joined because many family members were also members and were very pleased with services they needed. I can't say enough good about the way I've been helped (nothing major, though). Have been totally unaware of the negative experiences of other posters. All I can say is I've been treated like Gold. read more

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!!! read more

I have been with Fallon for only nine months. So far I feel like I am throwing my money away. Luckily I am healthy, however I do take 1 medication. So far, 9 months and still no coverage for a treatment that would actually save them money in the long run. My doc and nurses have jumped through hoops trying to get prior authorization only to be denied at every turn. Stay away! read more

This is also the first review I have ever written. The reason I chose to write this review is because I needed something to do as I STILL have been waiting on hold with FCH...the official wait time is at 42 minutes and counting. I applied for a plan and was approved, then 5 days later come to find out that my claim was never processed. I had to cancel a doctor's appt. and have had to go days without Rx meds. As a secondary warning, never use ehealthinsurance to get health insurance. They have blamed FCH for the mix up and Fallon has blamed them and the finger pointing and I have made 8 phone calls in the past 3 days trying to get this straightened out. The customer service representatives have not been accommodating and scoffed at the idea of a refund or pro rate. So basically at this point I have paid FCH $100 dollars and in return I have gotten no health insurance coverage and approximately 2 hours of wait time over the phone. Don't waste your time or money like I just had to. read more

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! read more

I have been a Fallon Select Care member for nearly 10 years and I am extremely disgusted with their 'ItFits' reimbursement program. For anyone that doesn't know about this program Fallon will reimburse you $150 for a year of some sort of fitness expense - I.E. gym membership or any other activity that you have to pay for. Every year I submit my forms for the $150 reimbursement and every year they seem to forget where I live, or they send a check to the wrong address, or blatantly lie to me that it's in the mail. So here it is my fourth year I submitted my paperwork back on May 2 of 2018 and I'm still having the call into them every two weeks to find out what the hold up is. I can't even tell you how many times I've called and they have told me that they needed to update my address, even after it already been updated on several other calls. (I believe in the first 4 calls I made they "updated" it). Funny thing is their bills seem to find me just fine and my new/renewal insurance card from April showed up in the mail just fine. I just called again on June 21 and they told me that my paperwork finally made it to the reimbursement department and the ABSOLUTE latest I should get the check is July 5th. If it were money I owed them and I was 2 months behind on paying it you know id be hit with late fees and eventually collections. I'm so sick of excuses from Fallon that I may very well change health insurance at my next employer's election period. I work in the medical field and if the company I work for was this unorganized with billing and reimbursements they'd be out of business. read more

Fallon Health is about as bad as it gets. Twice in a month I am denied treatment or a prescription. You can not speak to an intelligent person, they all call themselves case workers. Reality they are call servicing hires who have no medical training. They lie, in my case the claim the medication is not FDA approved, I gave them the approval FDA number, then my doctor did not file for a pre approval. Then they said someone within 24 to 48 hours will call you from the expedited service department. OMG same stupid so called, call service person with no credential telling me the drug is not FDA approved. This is not rocket science, but a long as Fallon Health Care delays and denies they save money. State of MA needs to shut them down. I am sure many are dying waiting for service it is more than obvious how bad they are. Read the MA state review http://healthinsuranceratings.ncqa.org/2017/HprPlandetails.aspx?id=14 category getting care 2.5 out of 5 not very good. Consumer satisfaction 3.00 again not good. My suggestion get away from Fallon Health Plan as fast as you can. With Fallon Health care you are putting your safety at serious risk. Don't bother with their grievances file directly with the state of MA. https://www.mass.gov/files/documents/2019/01/17/2017%20OPP%20Annual%20Report.pdf link to 2017 annual report from office of patient protection, released January 2019. Internal Review page 5 Fallon Health care has 3.3 complaints while the closet BCBSMA has 1.0 with the State average being 0.75. Again the State of MA is well aware that Fallon denies coverage and Prescriptions why has the state for 2 years turned a blind eye to this abuse? read more

Unfathomable to the extent I urge anyone to avoid this insurance company. Fallon is by far the worst. I have had to switch primary care physicians in excess of up to five times in a couple of years. Doctors are leaving practices right and left. I currently am looking for my next primary care physician in the midst of a health crisis. I had a seizure about a month ago and need follow up with yet another physician. I currently have no providers with my current health status. If anything happens, I need to go to an E.R. and pay their obscene copays. Yes, hard to believe that we who worked all our life need go through so much torture. Our society, as a whole, needs a total overhaul in the health insurance industry. Obumma care a major factor in the failed health system. read more

I have had Fallon Back cause for several years now. I think they are awesome!!! I have COPD and chronic arthritis. Every piece of equipment my doctor asked for I received. An oxygen compressor...a nebulizer...a by-pap machine. Also portable oxygen tanks....a shower chair...a walker...AND a hospital bed. I never had problems with referrals or prior authorizations. Also we get the perk of 40+ $$$ quarterly.I really don't know why there is so much negativity. The problem is not the insurance but the doctor sending in the prior. I went through what you all are going through now. Give it a chance. read more

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. read more

Fallonhealth sucks. The worst health plan that I ever had to deal with. There customer service is a joke. I can't wait to switch to another provider. read more

Great health plan. One of the best you could get Outstanding customer service - five stars for the plan and customer service. However, the rep couldn't answer my questions and sent me to Nurse Connect, which turned out to be useless. Nurse Connect gets 1 star. The RN I talked to hardly gave me the time of day. She did not give a shit and it came through. Then she told me to call Employee Advantage which is the same as calling customer service ...after I told her I had just talked to customer service and they sent me to Nurse Connect. I would say to Fallon, please improve hiring in your Nurse Connect area as they were not helpful at all, but the rest of this health plan is awesome. read more

Fallon Health is so horrible, I can't believe it is allowed to exist. As some other reviewers have stated if you call for help you will get different answers each time. One lady tried to get me to explain my health issues, which is creepy and rude. Their higher ups are rude too. Avoid at all costs! read more

Absolutely terrible! Every single medical and dental bill has been messed up. Have a $1000 a month top of the line plan and they still can not tell me after 3 phone calls whether they will cover blood work or not. Dental is a joke. Covered one of my kids in full for preventative care, and won't cover the other one who went at the same time for the same service. Website shows about 50 dentists in my home town that take the plan. Called everyone and not one actually takes it. Been with every other major health plan and never had an issue. Do yourself a favor and pay the little extra a month for a better carrier. You will save that on the first bill these guys send you... Hopefully, no one in my family actually has a major medical problem before we can switch plans in June! read more

This company has been nothing but terrible. I am chronically ill and I have needed a "prior authorization" for pretty much every thing I've needed to get- from tests to pills. It's exhausting and makes me more ill due to the stress of it all. A sick person with two young kids and a full time job should not have to add another job of calling again and again. I will tell anyone who listens to never use them. I'm going to go back and pay way more for an actual insurance company. Oh, and it took 6 months for them to give me my "it fits" money. They kept losing the forms. And then telling me I did it wrong and then telling me they didn't know why it was wrong because it was right. Yeah, doesn't make sense, huh? That's exactly how I felt. I am pretty sure their policy is pay for nothing unless we will get sued for saying no. Oh, and say no first. Then, hope they don't fight back because hopefully they are too sick to do so. If they fight back, they will have to do it multiple times. I work for one of the wealthiest towns in the country and they provide the worst insurance I have ever had. read more

I am a self-employed person with a family living in MA where you need health insurance. I have none provided by employer, so I had to go farm out insurance. After some research, I found Ehealthinsurance and Fallon was the only one available for me. I needed coverage for a pre-existing condition for a family member and needed prescription coverage and hospital coverage. After speaking with a representative, I was told this plan would fit my needs. I am here to tell you that this is the absolute worst insurance I have ever had. This insurance DOES NOT cover any pain medication after a surgery. DOES NOT cover diabetes test strips, but makes you buy a specific meter, which is $70. The pharmacist told us we should keep our old meter and buy the strips over the counter for the same price as the prescription coverage. This insurance is the worst, according to our pharmacist, because they DO NOT cover ANY stomach-related medications. I am paying over $1,000 a month and am getting nothing covered. The fun part is that also despite having changed to this insurance with nothing else being changed as far as doctors, we now need a prior authorization for things we have been taking and doing for years. I absolutely hate this insurance. I am waiting for the Obama care thing to go forward and hopefully I can get rid of this and get to something else. read more

The worst health insurance carrier I've ever dealt with. Their Senior Plan Medicare Supplement looks good on paper, but no one -- and I mean NO ONE -- has ever heard of them in my community. I live in Dartmouth, Massachusetts, and on a few occasions when I was recommended to a primary care physician by Fallon, when I contacted the health care provider, they all said they do not accept this Plan. And their dental coverage, which is supposed to be included in this Plan, is practically nonexistent. Their systems are outdated; communication is poor within their organization, and woefully inept. All I can say is, "beware, seniors, and look for insurance elsewhere." I have since switched to the AARP - UHCP supplement, and they are superb by comparison. read more

The abosulte WORST insurance company ever! Staff is not knowledagble and has poor communication between departments. Their systems are dated and they have to do everything manually. Your money means nothing to Fallon Health. read more

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. read more

I had the insurance and I worked here for over a year. The only reason I left was to be closer to my children. I wish I still had the insurance- they really do what they can to help people- chances are the people who hate them just had to be told no, but that's just the way life is sometimes. read more

Terrible insurance. If your job is considering switching over to this provider do everything you can to prevent it. I'm currently seeking help for medical concerns and my company has Fallon. It's taken me months of jumping through hoops to get approvals for something that needs immediate attention because Fallon's network of doctors is so poor. If you need to see some one for more than a yearly physical or a specialist/ some one not in their network good luck hope you can wait. On top of that I called the service line and I was given a list of specialists in network. None of them are accepting patients. Super helpful. This is cut rate insurance and you get what you pay for. read more

As a former employee, I wanted to write a review to warn all potential employees and especially current and prospective members to NOT KEEP OR OBTAIN THIS INSURANCE! I was an employee here for about 6 months and quit because the call center was horribly managed and reps didn't know what they were talking about and always gave members the wrong information for benefits and deductibles and pretty much any questions they had. Management never wanted to take escalated phone calls which put reps in an awkward position. Entire company is micro managed. My direct manager whose name is Kim Murray was a complete- C U Next Tuesday (if you get what I'm saying). She was fake, played favorites and had brown shit all over her nose from kissing ass! Management was a group of besties and didn't care who needed help or how poorly the office was handling member calls. I would NEVER recommend anyone to work here or recommend any person looking for insurance to get Fallon because they SUCK and LIE TO YOU. I hope the company goes under. read more

I would not recommend Fallon. The individual prices are decent, but their customer service is terrible. They never call you back or follow through with what they tell you they will do. I would not recommend going with Fallon. read more