Fallon Health for Medical Detox

Fallon Health covers behavioral health services including substance use disorder treatment. To determine your coverage, reach out to our Admissions Department or use the MyFallon member portal to find your summary of benefits. Solution Based Treatment offer alcohol detox, fentanyl detox and benzodiazepine detox as well as other detox programs.

Fallon Health Coverage for Residential Treatment

Residential care, which is SUD treatment that requires you to stay overnight and that is normally between 30 and 90 days long, is covered by Fallon Health. For example, Fallon Health-Atrius Health Care Collaborative members with MassHealth standard coverage can receive residential rehabilitation services with pre-authorization. Your exact coverage will vary based on your plan. 

Fallon Health Coverage for Outpatient Treatment

Fallon Health insurance plans may cover outpatient treatment. Your coverage will vary based on your plan. Review your schedule of benefits or reach out to our team for help discerning your coverage.

Intensive Outpatient Programs (IOP)

Intensive outpatient programs (IOP) take place a few days a week for several hours a day. Fallon Health may cover IOP treatment with pre-authorization. Our Admissions Department can assist you in determining your benefits. 

Partial Hospitalization Programs (PHP)

Partial hospitalization programs (PHP) are for those who don’t qualify for inpatient treatment but who need inpatient-level care during the day with the option to return home at night. Fallon Health may offer coverage for these intensive programs depending on your plan. 

Outpatient Treatment

Outpatient treatment is a standard in the industry and often covered by insurance companies. Fallon Health may cover medically monitored services, recovery coaching, structured outpatient addiction programs (SOAP) or other outpatient services with or without pre-authorization (depending on your plan). Our Admissions Department can help verify your coverage to help you choose the right SUD treatment program for you. 

Fallon Health Rehab Coverage FAQs

Does Fallon Health insurance cover drug and alcohol rehab?

Yes. Fallon Health insurance offers coverage for drug and alcohol rehab. Depending on the plan, it may offer in-network or out-of-network coverage. Call our Admissions Department at (833) 999-1941 to determine if you have out-of-network benefits. 

How can I verify my Fallon Health insurance benefits?

To verify your Fallon Health insurance benefits, contact our Admissions Department at (833) 999-1941. You can also verify your benefits, view your benefits documents, and more at MyFallon. 

Does Fallon Health cover outpatient addiction treatment?

Fallon Health may cover outpatient addiction treatment at a rehab or detox program Fallon Health insurance has as an in-network or out-of-network provider. 

Does Fallon Health cover inpatient mental health?

Rehabs that take Fallon Health may have inpatient mental health care services covered 100%. Our Admissions Department can determine your benefits and if your care will be covered in full.

Do treatment centers need to be in-network?

To get the most coverage out of your Fallon Health insurance plan, it’s a good idea to stay in-network. However, some Fallon Health plans do have out-of-network coverage to allow you to choose any SUD treatment facility for your care.

How much does Fallon Health insurance cover?

The coverage you’ll have through Fallon Health insurance will depend on the services you’re seeking and if the provider is in- or out-of-network. You may need to pay a deductible and co-payments to meet your maximum out-of-pocket costs before your insurance will pay. Our Admissions Department can help determine how much coverage you have and how much you’ll need to pay out-of-pocket for your SUD care.

How do I pay for costs not covered by Fallon Health insurance?

For any costs not covered by Fallon Health, you’ll need to set up a payment plan, use cash, pay by card, or seek out other support (such as SUD scholarships or grants) to pay for your care.

How is a Fallon Health HMO different from a PPO?

An HMO is different from a PPO because the HMO has its own preferred network of providers. You may pay less on this plan, but out-of-network coverage is typically not provided. 

On the other hand, a PPO may cost more each month, but you have more freedom to choose your providers. PPOs often have preferred in-network providers but also out-of-network coverage to allow you to choose who you see. 

Can you get a single case agreement with Fallon Health?

Fallon Health has several different kinds of insurance plans, and the option for a single case agreement may be available to help you continue care with a provider you trust. Contact Fallon Health at 1-800-868-5200 to see if you need a single case agreement to stay with your preferred provider. 

Solution Based Treatment offers inpatient services to patients from all over America and outpatient and day treatment to clients in the following areas:

• Temecula, CA
• Murrieta, CA
• Menifee, CA
• Wildomar, CA
• French Valley, CA
• Lake Elsinore, CA
• Canyon Lake, CA
• French Valley, CA
• Corona, CA
• Vista, CA
• Escondido, CA
• San Marcos, CA
• Fallbrook, CA

Sources:

https://www.fallonhealth.org/en/atriushealth/whatscovered