Public Mediation

M.F. vs. Fallon Health - Worcester, Ma

M. F. vs. Fallon Health Insurance - Worcester, Ma
10 Chestnut St Ste 1, Worcester, Massachusetts, 01608-2805, United States
Amount Involved: Other terms
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Statement of Claim
Complaint Involved (1) - View
"Health Plan for the town of Westford, MA was deceptive. The Fallon Health Insurance plan was suppose to be just like BC/BS. I have the best plan they offered was a PPO, PHCS which would cover medical out of state. I moved to Florida in August 2016. With BC/BS for medical and dental in Florida I could go anywhere and be seen by qualifield Medical Personal. In Mid Octlber, 2016
I was notified the Town of Westford was changing its Medical and Dental Insurances. I recieved
no written information on the plan until Nov. 22, 2016, The plan is NOT covering my needs in Florida: PHCS is not accepted because they will not PAY, Case Managers from Fallon has given me the numbers and numerous Dr.'s to call. PHCS gave me 22 doctors (psychiatrists) to CALL who were in Network. When I called them, they would NOT accept PHCS. I have spent HOURS and DAYS on the phone with Fallon, American Health (Who they outsource to, claim was denied because they think is is cosmetic surgery, while my Laser surgery would release scar tissue and provide me with better medical healing. I have nails in both hands, and through my fingers.
I have not been sleeping because of the pain. This is all documented with my Hand Physical Medicine specialist at Manatee Hosptial in Bradenton, FL. The continuous stress Fallon has caused me has resulted in my going backwards with my Pyschological therapy. I have been working so hare to more forward, but feel Falon Is not addressing this manner in a Professional
Medical Manner. I have reached my limit with uncaring, non-working case managers (I now have my 4th one) who can not help me when I need it. Please help."
...
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What Claimant Wants Hide
Just make me happy!
Claimant invites Fallon Health Insurance - Worcester, MA to make a fair offer.
1. Other – Pay for claim posting cost Mar 25, 2017 $7.99
Cash total : TBD
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Respondent's Counteroffer Hide
The claimant's settlement terms were rejected with the following explanation:

  • "Fallon Health apologizes for any confusion. We have reviewed the member’s concerns and have discussed these concerns with her on Friday March 17, 2017. Ms. Frost was provided contact information for two individuals at Fallon Health if she has any further concerns. She is also able to call Fallon Health Customer Service at 800-868-5200."

This claim will remain posted until resolved.

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  • Contributed Solution: by Bob Mangione On 03-22-2017
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    File a complaint with your insurance commissioner and congressman/woman More...
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