| Service | Root Canal treatments (not on third molars) | Is it covered for children? (Members younger than age 21) | YES | Is it covered for adults? (Members age 21 and older) | YES | Is a Prior Authorization Needed? | NO |
|---|
What type of insurance is Fallon Wellforce?
Wellforce Care Plan is a
MassHealth Accountable Care Organization (ACO) Partnership Plan
. It is made up of the Wellforce Care Plan ACO and Fallon Health. The Wellforce ACO is a group of hospitals and providers who have agreed to work closely together to take good care of you and your family.
Is Fallon Health an HMO?
Fallon Health's product portfolio includes HMO, POS and PPO plans
as well as Medicaid and Medicare Advantage plans.
Is Fallon Health a nonprofit?
Fallon Health is
a non-profit organization
that holds contracts with the Centers for Medicare & Medicaid Services (CMS), the Massachusetts Medicaid program (MassHealth) and the New York Department of Health (NYDOH).
How many members does Fallon Health have?
For 2018, Fallon Health had
271,369 members
– an increase of nearly 24 percent over 219,112 members in 2017, and revenue of $1.6 billion – a 21 percent increase over revenue of $1.3 billion in 2017.
Does MassHealth cover teeth implants?
Currently, MassHealth covers fillings for the most visible six front teeth on the top and bottom, as well as extractions of all teeth. Starting in January, coverage will expand to include fillings of all teeth, but
implants will still not be covered
nor will dentures, root canals or crowns.
Does MassHealth cover crowns 2021?
Dental Coverage Restoration
MassHealth patients over the age of 21 are now able to access a greater number of dental services. Previously, adults could only get restorations (fillings) and extractions. Now,
they are also entitled to root canals and crowns
, which will save more teeth.
What dental procedures are covered by medical insurance?
A few of the procedures that are covered under dental insurance include
filling of caries, tooth extractions, dentures, root canal procedures
, etc.
Is Wellforce care plan part of MassHealth?
What is Wellforce Care Plan?
Wellforce Care Plan is a MassHealth Accountable Care Organization (ACO) Partnership Plan
.
Who qualifies for MassHealth?
To be eligible for this benefit program, you must be a resident of Massachusetts and meet all of the following:
18 years of age and under, and
.
A U.S. Citizen, National, or a Non-Citizen legally admitted into the U.S, and
.
Ineligible for Medicaid
.
Fallon Health Connector options
PCP referral is required for in-network specialty care
. Out-of-network specialty care requires prior authorization. Members of Direct Care are eligible for the Peace of Mind ProgramTM.
How do I know if my MassHealth is active?
- Access member eligibility information from the EVS Internet site through the POSC.
- Click Manage Members.
- Click Eligibility.
- Click Verify Member Eligibility. …
- On the Check Member Eligibility panel, select the provider from the drop-down list.
- Enter either the member's:
What does MassHealth?
MassHealth
provides health benefits and help paying for them to qualifying children, families, seniors, and people with disabilities living in Massachusetts
. We may offer benefits directly or help pay for all or part of your health insurance premiums.
Does MassHealth cover jaw surgery?
MassHealth does not cover orthognathic surgery for cosmetic purposes
. precludes adequate treatment through dental therapeutics and orthodontics.
Does medical cover dental implants 2020?
Dental implants are covered by health insurance when you can prove that the treatment is medically necessary
. Qualifying services are “appropriate to the evaluation and treatment of a disease, condition, illness, or injury and are consistent with the applicable standard of care.”
Will MassHealth pay for temporary dentures?
The MassHealth agency pays for removable partial dentures if there are two or more missing posterior teeth or one or more missing anterior teeth, the remaining dentition does not have active periodontitis, and there is a favorable prognosis for treatment outcome.
Does MassHealth cover periodontal disease?
The MassHealth agency pays for a comprehensive periodontal evaluation once per calendar year per member; per provider or per location
. A comprehensive periodontal evaluation is indicated for members showing signs or symptoms of periodontal disease and for members with risk factors such as smoking or diabetes.
Does MassHealth cover wisdom tooth extraction?
Dental Services Covered By MassHealth
Oral surgery includes a variety of procedures, one of the most common is the removal of impacted wisdom teeth for teens and adults
. Wisdom tooth extraction requires surgery as the teeth may not come through the gum line.
Does MassHealth cover white fillings?
Dental Care Under MassHealth
As for adults, diagnostics and preventative dental services, extractions, emergency dental treatments, and
all types of fillings for all teeth are covered
.
