Frequently asked questions
What is Fallon 365 Care?
Fallon 365 Care is a MassHealth Accountable Care Organization (ACO) Partnership Plan. It’s made up of Reliant Medical Group and Fallon Health. All are health care leaders who have been caring for MassHealth members for decades.
As a member, all of your health care is managed by your primary care provider (PCP). Your PCP will work with Fallon 365 Care’s group of doctors and medical centers to give you great health care.
What is an Accountable Care Organization (ACO)?
An ACO is a health plan that’s accountable to provide you with high-quality care. An ACO helps you meet your health goals. ACOs have groups (networks) of PCPs and other providers. They work together to meet your overall health care needs. In an ACO your PCP and their team is responsible for working with you and your other providers. They’ll help coordinate your care and connect you with available services and supports. This coordination will help you get the right care at the right time.
How can I be sure my PCP is part of Fallon 365 Care?
All Reliant Medical Group PCPs are part of Fallon 365 Care.
How do I join Fallon 365 Care?
To join Fallon 365 Care, you must:
- Qualify for MassHealth
- Have a Reliant Medical Group primary care provider
- Live in one of the cities or towns in our service area
If you meet the requirements above, call MassHealth to enroll. They can be reached at 1-800-841-2900 (TTY: 1-800-497-4648). They’re available 8 a.m. to 5 p.m., Monday through Friday. Or, visit MassHealthChoices.com
Will I pay more for Fallon 365 Care?
No. There’s no cost to join Fallon 365 Care.
I see doctors who aren’t with Reliant Medical Group. Can I still see them as a member of Fallon 365 Care?
Maybe. Fallon 365 Care has a limited network of health care providers. You can only see providers who work with Fallon 365 Care. Fallon 365 Care is made up of Reliant Medical Group providers. If your providers aren’t with Fallon 365 Care, you probably won’t be able to see them. However, your Reliant Medical Group provider may let you see other providers if it’s necessary for your care.
What benefits do I get with Fallon 365 Care?
As a Fallon 365 Care member, you are covered for many important health care services, including doctor visits, hospital stays, rehabilitation and therapeutic services, and behavioral health and substance use disorder services. You’ll also get these healthy extras:
- Free rides for emergencies
- A free car seat and other “little extras” with the Oh Baby! program
- A free online health resource with info on conditions, medicines and other health topics
- Free help for people with asthma, heart disease, diabetes or chronic obstructive pulmonary disease (COPD)
Fallon 365 Care can help you get counseling services. They can teach you about children’s services. And they can show you how to apply for food stamps and much more.
What providers can I see?
You can see providers from the following locations:
- Reliant Medical Group
- MetroWest Medical Centers in Framingham and Natick
- ReadyMED locations in Auburn, Hudson, Milford and Worcester
- Saint Vincent Hospital/Worcester Medical Center
Will I be able to continue to see my specialists?
If you have a Reliant Medical Group PCP, and your specialists are part of the Fallon 365 Care network, you will be able to continue to see your specialists. To be sure that you can continue to see all of your doctors, you must make sure that they are in the Fallon 365 Care network. You can do that by calling Fallon Health at 1-855-508-3390 (TRS 711) from 8 a.m. to 6 p.m., Monday through Friday. Or, you can look up doctors online by following the "Find a doctor" link below.
If your specialist is not a part of the Fallon 365 Care network, you will need to contact your PCP to determine if you can continue to see this specialist. You may need a referral or a Prior Authorization for some of your providers.
What is My Ombudsman?
My Ombudsman is an independent organization that helps individuals, including their families and caregivers, address concerns or questions that may impact their experience with a MassHealth health plan or their ability to access their health plan benefits and services. My Ombudsman works with the member, MassHealth, and each MassHealth health plan to help resolve concerns to ensure that members receive their benefits and exercise their rights within their health plan.
My Ombudsman is knowledgeable about member rights, contractual requirements of each health plan, benefits and services available to members, as well as resources in the community. My Ombudsman is able to connect with representatives at health plans and at MassHealth to investigate and resolve concerns quickly and appropriately.
Call: 1-855-781-9898
Email: info@myombudsman.org
Website: www.myombudsman.org
Office: 11 Dartmouth Street, Suite 301, Malden, MA 02148. Office is wheelchair accessible.
Walk-in hours: Mondays 1 p.m.–4 p.m. and Thursdays 9 p.m.–12 p.m. and by appointment.
Questions about Fallon 365 Care?
Call us at 1-855-508-3390 (TRS 711) from 8 a.m. to 6 p.m., Monday – Friday.
Questions about MassHealth?
Call MassHealth at 1-800-841-2900 (TTY: 1-800-497-4648). They are open 8 a.m. to 5 p.m., Monday through Friday. Or, visit MassHealthChoices.com.
