Medical, Dental, Pharmacy and Vision Claims Administrators
The Fund does not process or administer medical, dental, pharmacy or vision claims. The Board has contracted with three (3) separate organizations to provide administrative services, such as claims processing, individual case management, utilization review, quality assurance programs, claim review and other related services and to arrange for a network of health care providers and/or prescription drug providers whose services are covered by this Plan. The names and addresses of the three (3) organizations are:
Blue Cross Blue Shield of Massachusetts, Inc.
401 Park Drive
Boston, Massachusetts 02215-3326
Fallon Health Plan
10 Chestnut Street
Worcester, Massachusetts 01608
Davis Vision, Inc.
175 East Houston Street
San Antonio, Texas 78205
Davis Vision Live Support: 1-800-999-5431
Customer Relationship and Information Technology Center
Capital Region Health Park, Suite 301
711 Troy-Schenectady Road
Latham, New York 12210
None of these organizations serve as an insurer, but rather, serve as claims processors. Claims for benefits or services are sent to these organizations. They process the claims, then request and receive funds from the Plan to pay these claims, and they in turn, make payment to doctors, hospitals and other providers. Each of the organizations has sole and complete discretionary authority to determine claims and appeals in accordance with the terms of the documents or instruments governing the plan in which you are enrolled.