Community Care members (commercial plans)
MyFallon online tools
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Cost information
As health care evolves and costs continue to rise, you are being asked to share more of the expense. Learn more about health care costs and what you may be responsible for paying.
Quick facts about your commercial behavioral health benefits
- You do not ever need prior authorization to be admitted as an inpatient to a facility from a licensed emergency department to receive behavioral health care.
- You do not need to obtain prior authorization for routine behavioral health care visits.
- The following outpatient behavioral health services require prior authorization:
- Psychological and neuropsychological Testing
- Transcranial Magnetic Stimulation (TMS)
- In accordance with Massachusetts state law we do not require prior authorization for substance use disorder services if the provider is certified or licensed by the Department of Public Health (DPH). In addition prior authorization and medical necessity review is not required for Acute Treatment Services and Clinical Stabilization Services for up to 14 consecutive days.
- You are covered to receive an annual mental health wellness exam. This exam can be performed by either a licensed mental health professional or your primary care provider.
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Important update
Effective January 1, 2024, Harrington PCPs and specialists are no longer part of the Community Care network. In certain circumstances, you may be able to continue to receive services from your provider. For more information about continuation of coverage, refer to your Evidence of Coverage/Member Handbook, or contact Customer Service at 1-800-868-5200 (TRS 711).