Fallon Health Insurance Review & Complaints: Health Insurance (2024)
Fallon Health, or Fallon community Health Plan, is a full-service HMO health system. Their plans have a $5 copay for primary care office visits, no charge for routine lab and other tests, and prescription coverage starting at $1 for Tier 1 drugs.
Free Health Insurance Comparison
Compare Quotes From Top Companies and Save
Secured with SHA-256 Encryption
Eric Stauffer
Founder & Former Insurance Agent
Eric Stauffer is an insurance agent and banker-turned-consumer advocate. His priority is educating individuals and families about the different types of insurance coverage. He is passionate about helping consumers find the best coverage for their budgets and personal needs. In addition to founding Expert Insurance Reviews, Eric is the CEO of C Street Media, a full-service marketing firm and the...
Founder & Former Insurance Agent
UPDATED: Mar 12, 2024
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code on this page to use the free quote tool. The more quotes you compare, the more chances to save.
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.
UPDATED: Mar 12, 2024
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance companies please enter your ZIP code on this page to use the free quote tool. The more quotes you compare, the more chances to save.
On This Page
Your one-stop online insurance guide. Get free quotes now! Secured with SHA-256 Encryption
About Fallon Health
Fallon Community Health Plan was founded in 1977, to provide insurance and services to Massachusetts residents. They were the state’s first HMO to be qualified by the federal government, and among the first HMOs to receive a Medicare contract. By 1989, Fallon Health was the fourth largest HMO in Massachusetts, and they went on to earn more accolades, including the first accreditation of an HMO by the National Committee for Quality Assurance, and being named among Newsweek’s top HMOs in 1999.
Fallon Health expanded to parts of New Hampshire in 2009, and in 2014 expanded into New York through a partnership with the Weinberg Campus. In that same year, the word Community was dropped and the name Fallon Health became official. Today they are the only health system in the state that is both an insurer and a provider of care.
Fallon Health offers individual and group health insurance plans as well as being a leader in Medicare Advantage plans. As we have covered their Medicare plans in a separate review, this review will focus on their individual health products. Their headquarters is in Worcester, MA. Your one-stop online insurance guide. Get free quotes now! Secured with SHA-256 Encryption
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
Secured with SHA-256 Encryption
Fallon Health Plans
We found the Fallon website to be frustrating in terms of finding information on the available plans, even during the open enrollment period when this review was written. In the section that is aimed at individuals shopping for insurance, there is no comparison chart, no quick link to a list of plans with benefits overviews, not even a list of which plans are available and what levels are offered.
There was a very basic overview of the coverage without a breakdown by plan level. The overview stated that plans have a $5 copay for primary care office visits, no charge for routine lab and other tests, and prescription coverage starting at $1 for Tier 1 drugs.
We were able to obtain plan information through the individual page by requesting a quote, which re-directed to the eHealth website and returned information for plans from other local companies as well. (For more information, read our “eHealthInsurance Review & Complaints“).
By entering a quote request for a 30-year-old male living in Worcester who does not qualify for financial assistance, we were given a list of six HMO plans at the Gold and Platinum levels. While it seemed unlikely that Fallon would not have Bronze or Silver level plans, none of these were given as an option on our search.
Our search did confirm that primary care office visits have a $5 copay across the board, but deductibles vary. The two Platinum plans had no deductible, while the four Gold plans had either $1,200 or $2,000 deductibles. The search also confirmed the prescription coverage starting at $1 for preferred generics (Tier 1) drugs.
The Gold plans have a $15 specialist visit copay, while the Platinum plans have a $10 specialist copay.
All of these plans are HMO and offer no out-of-network coverage with the exception of emergency care.
After more searching through the website, we found a plan chart in the section aimed at brokers. This chart includes an incredibly confusing array of plans including HMO and PPO options at every level and not a clear way to compare them. As an insurance company, they do seem to offer a wide variety of plans.
Plans are broken down into copay, coinsurance, deductible, and qualified high deductible, and then again by metal level from Catastrophic to Platinum. The chart lists plans with the Direct Care limited network, the HMO network, and the few that offer a PPO network.
Overall, the system for providing plan information on the site is clearly aimed at brokers who understand insurance and not at individuals shopping for insurance. The broker section listed far more plans than we saw when searching for plans and rates as an individual. It is unclear why the quoting system returns so few options on a quote request, and yet many more are offered when a broker is obtaining a quote (through a different system). Sometimes, Fallon Health is misspelled as Falon Health.
Read more: Fallon Community Health Plan Insurance Review & Complaints: Health & Medicare Supplement Insurance
Rates
We were able to return rate quotes, but only for the Gold and Platinum level plans that the system offered. The lowest priced option was the Direct Care Deductible 2000 at the Gold level, with a premium of $413.66 a month.
As an individual shopping for insurance, a system that returns a Gold plan as the most affordable level option needs some attention. We would expect to see a Bronze level plan offered at the very least, if not a Catastrophic plan at half the price of this Gold plan. This is particularly strange for a quote that is being offered to a single male of 30 years old, generally the target market for lower monthly premiums with more out of pocket costs.
How Fallon Health Manages Claims
Ease of Filing a Claim
Fallon Health offers multiple channels for filing claims, providing convenience to its policyholders. You can file a claim online through their website, over the phone, or via their mobile app. This flexibility allows customers to choose the method that suits them best.
Average Claim Processing Time
Fallon Health’s efficient claims processing is essential for a smooth customer experience. To get precise information on claim processing times, customers can contact the insurer directly or visit their website for updates.
Customer Feedback on Claim Resolutions and Payouts
Customer feedback plays a crucial role in evaluating an insurance provider’s claim resolution and payout process. Prospective policyholders may want to explore external review platforms and forums to gather insights from current or former customers regarding their experiences with claim resolutions and payouts.
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
Secured with SHA-256 Encryption
Digital and Technological Features of Fallon Health
Mobile App Features and Functionality
Fallon Health offers a mobile app to enhance customer experience. Interested individuals should visit the app store for their mobile device to download the Fallon Health app and explore its features, which may include policy management, claims submission, and access to health resources.
Online Account Management Capabilities
The insurer likely offers online account management capabilities to policyholders, allowing them to access policy information, view claims status, and make payments conveniently. Detailed information about these capabilities can be found on Fallon Health’s official website.
Digital Tools and Resources
In today’s digital age, insurance companies often provide policyholders with various digital tools and resources to help them make informed decisions about their healthcare. Fallon Health may offer resources such as online health assessments, cost calculators, and educational materials to support their customers’ health and well-being.
Ratings and Consumer Reviews
Fallon Health has an A+ rating with the Better Business Bureau (BBB), with only one complaint in the past three years.
The National Committee for Quality Assurance gives Fallon Health an overall rating of 4.5, which is very good. It is well worth noting however that in the breakdown by category, they earn only a 3.0 in consumer satisfaction, with rankings of 2.0 for getting care quickly and primary care satisfaction.
We found very little in the way of other reviews, especially noting a lack of direct consumer reviews of Fallon’s services.
The Bottom Line
Fallon Health appears to have a good reputation but makes shopping for insurance frustrating and confusing due to a poorly organized website that appears to place brokers above consumers in terms of information provided. We are unable to give a clear picture of rates since our search only returned six of Fallon’s highest-priced plans and no budget options. Fallon Health may well have great plan options, but customers will have to contact a broker or call directly to get a clear picture of what’s available. Your one-stop online insurance guide. Get free quotes now! Secured with SHA-256 Encryption
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
Secured with SHA-256 Encryption
Frequently Asked Questions
What is Fallon Health Insurance?
Fallon Health Insurance is a health insurance company that provides coverage for individuals and families. They offer a range of health insurance plans and services to meet the healthcare needs of their customers.
How can I review Fallon Health Insurance?
To review Fallon Health Insurance, you can visit various online platforms such as review websites, social media platforms, and consumer advocacy websites. These platforms often feature customer reviews and ratings to help you assess the quality of service provided by Fallon Health Insurance.
What should I consider when reading Fallon Health Insurance reviews?
When reading Fallon Health Insurance reviews, consider factors such as customer satisfaction, the range of coverage options, the efficiency of claims processing, the accessibility of healthcare providers, and the overall customer service experience. Look for patterns and common themes in the reviews to get a comprehensive understanding.
Where can I find complaints about Fallon Health Insurance?
Complaints about Fallon Health Insurance can be found on several platforms. You can check the Better Business Bureau (BBB) website, online forums, social media groups, and consumer complaint websites. These platforms often provide insights into specific issues or concerns raised by customers.
Are you looking for free insurance quotes?
Your one-stop online insurance guide. Get free quotes now!
Secured with SHA-256 Encryption
Eric Stauffer
Founder & Former Insurance Agent
Eric Stauffer is an insurance agent and banker-turned-consumer advocate. His priority is educating individuals and families about the different types of insurance coverage. He is passionate about helping consumers find the best coverage for their budgets and personal needs. In addition to founding Expert Insurance Reviews, Eric is the CEO of C Street Media, a full-service marketing firm and the...
Founder & Former Insurance Agent
Editorial Guidelines: We are a free online resource for anyone interested in learning more about insurance. Our goal is to be an objective, third-party resource for everything insurance related. We update our site regularly, and all content is reviewed by insurance experts.