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.
Four 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 no longer need to obtain prior authorization after receiving 8 routine behavioral health care visits.
- The following outpatient behavioral health services require prior authorization:
- Psychological and neuropsychological Testing
- Transcranial Magnetic Stimulation (TMS)
- Electroconvulsive Therapy (ECT)
- 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.