Costs

As health care evolves and costs continue to rise, you are being asked to share more of the expense. But do you know the difference in cost between a visit to the doctor’s office and a trip to an urgent care center? How about the average cost for a hospital stay? Do you know what portion of those costs (if any) that you'll be responsible for paying?

Cost sharing

We negotiate and contract with plan providers to get you discounted rates for your covered health care services. Depending on your plan type, you may be responsible for paying a portion of the cost of your health care service. This is called "cost-sharing." Your cost-sharing may be in the form of copayments, coinsurance and/or deductibles.

• A copayment is the dollar amount that you need to pay for a covered service, usually when you get the service. For example, if your plan has a $20 copayment for doctor office visits, you'll pay $20 when you visit the doctor.
• Coinsurance is the percent that you need to pay for a covered service. For example, if you have a 20% coinsurance for a covered benefit, you pay 20% of the cost and the plan pays the rest..
• A deductible is the dollar amount that you pay before the plan starts to pay for certain services. For example, if you have a $1,000 deductible, you must pay up to $1,000 for certain services before your plan will start paying for them.

You can log into MyFallon to find out what your specific copayments, coinsurance and deductibles are. You can also find this information in your Summary of Benefits, Member Handbook or your other plan materials.

How to compare costs

• Online, with Sapphire365
  Sapphire365 is Fallon’s cost transparency tool, provides real-time health care cost comparisons. Shop for the right health care providers for you, based on cost and location.

1. Log into the MyFallon member portal. Or, if you don't have a MyFallon account yet, register to use MyFallon.
2. Click on the "My resources" tab.
3. Choose "Sapphire365" from the drop-down menu

• Call our Customer Service Department at:
  1-800-868-5200 (TTY: TRS 711)
  Monday, Tuesday, Thursday, and Friday from 8 a.m. to 6 p.m. and Wednesday from 10 a.m. to 6 p.m.
  
  
• Request a good faith estimate
  Complete a Request for Good Faith Estimate of Medical Services form (pdf) to get an estimate for proposed medical services.
  
  Things to consider when completing the Request for Good Faith Estimate of Medical Services form: The accuracy of the estimate depends on how accurate the information is on the form. To avoid delays in getting your estimate, please provide as much information as possible about the exact service you'll be receiving.  Also, please include information about any procedures, services or tests that are associated with the service. Some examples are: anesthesia, facility, pathology, tests or screenings and radiology. Make sure to choose how you'll like us to send the cost estimate to you. You can have it emailed** or sent through regular mail. Email will be delivered in 2 business days. Mail will be sent out in 2 business days to your address we have in our records. Mail delivery is dependent on the postal service.