Behavioral health benefits

Fallon Health partners with Carelon Behavioral Health to provide behavioral health services. Behavioral health services include mental health and substance abuse care.

Carelon Behavioral Health is available 24 hours a day, seven days a week at 1-888-421-8861.

You don’t need a referral from your primary care provider (PCP) to see a therapist. We encourage you to talk with your PCP about any behavioral health concerns you have.

  • For emergency or urgently needed care, call Carelon Behavioral Health immediately. If you or a family member are experiencing a mental health or substance use disorder crisis, you can also go to a Community Behavioral Health Center (CBHC).  CBHCs are available 24 hours a day, 7 days a week, 365 days a year. Go to the Community Behavioral Health Centers (CBHCs)/Mobile Crisis Intervention website ►
  • To find a provider for routine appointments, call Carelon during regular business hours. They’ll give you names and phone numbers of behavioral health specialists in your area, and you may schedule your own appointment.

    If you have any problems getting an appointment within 10 business days, call Carelon Behavioral Health and they will help get you an appointment.

For outpatient counseling, you do not need to get prior approval.

Some outpatient services require prior approval. If you have questions, call Fallon Health at the number on the back of your ID card, or Carelon Behavioral Health at 1-888-421-8861. 

Annual mental health wellness exam

You are covered to receive an annual mental health wellness exam. This once-a-year exam can be performed by either a licensed mental health professional or your primary care provider.

You will not pay a copayment or any amount toward your deductible for this exam, except if you are a member of the Connector Low Silver HSA plan. The Low Silver HSA plan is a qualified high deductible (QHD) plan, and federal rules mandate that QHDs apply most services towards the deductible. This means that if you get an annual mental health wellness exam, the cost of it is subject to your deductible, if you have not yet met it. If you have met your deductible, the exam will be covered in full.

Carelon Behavioral Health's website for Fallon members

Search behavioral health providers, download forms, find resources and more.

  1. Visit https://plan.carelonbehavioralhealth.com/
  2. Enter "Fallon Health" as your health plan.

Find a behavioral health provider

  1. Go to https://plan.carelonbehavioralhealth.com/find-a-provider/ 
  2. Fill in search criteria.
  3. To choose your plan type: look at the right side of your health plan ID card to find your plan name. If your plan name is:

    MassHealth Fallon Medicare Plus NaviCare Community Care
    Choose
    "Fallon Health – Atrius Health Care Collaborative” or “Fallon Health – Berkshire Fallon Health Collaborative” or “Fallon Health – Fallon 365 Care”
    as your plan type.    		 Choose “Fallon Health - Medicare Plus” as your plan type. Choose “Fallon Health - NaviCare” as your plan type. Choose “Fallon Health - Community Care” as your plan type.
  4. Check with the provider you are considering to make sure they accept your specific Fallon Health insurance plan or product.

Questions?

If you have questions about your benefits, call Fallon Customer Service at 1-800-868-5200.

If you have questions about a claim for behavioral health, call Carelon Behavioral Health at 1-888-421-8861.