Peace of Mind Program

Peace of Mind Program™

 

FCHP’s Peace of Mind Program provides access to specialty services at specified Boston area medical centers. You may access Peace of Mind Program providers at your request if you meet the following conditions:

  • The specialty service is ordinarily available in the FCHP Direct Care network
  • Care is for covered services as described in this Member Handbook. The same copayments and benefit limits apply.
  • You have seen a plan specialist for this same condition within the past three months.
  • A referral to a specific Peace of Mind Program provider is made by your PCP and notification of the referral is given to the plan.
  • The provider to whom you are referred is on staff at one of the six medical centers listed below:
    • Beth Israel Deaconess Hospital
    • Brigham and Women’s Hospital
    • Children’s Hospital (Boston)
    • Dana-Farber Cancer Institute
    • Massachusetts General Hospital
    • Tufts Medical Center
  • If you receive any hospital-based services such as surgery, lab or X-rays, these services must be performed at one of the above hospitals or at another plan facility. If you see a specialist through the Peace of Mind Program, and the specialist recommends or arranges services to be performed at a hospital that is not listed above, these services will not be covered unless the physician has obtained prior authorization from the plan. You must have a copy of the written authorization from the plan; do not rely on assurances by the physician regarding plan coverage.
  • As long as you have met the eligibility requirements, you have the right to access your Peace of Mind Program benefit. If you are having difficulty receiving a referral from your PCP, please contact FCHP Care Services at 1-800-333-2535, ext. 69138.

Once the plan has been notified of the Peace of Mind Program referral to a Peace of Mind specialist, you may see this specialist for a period of one year or until treatment for the presenting condition is complete, whichever comes first. When your course of treatment is complete, or for care for any nonrelated condition, you should return to your PCP for care.

If your Peace of Mind Program specialist wants you to see another specialist at the same facility for the same condition, your PCP must submit a separate referral to the plan before you see the other specialist.

If you want to see a Peace of Mind Program specialist for a different condition, the request must meet the Peace of Mind Program conditions described above for the second condition, your PCP must submit a referral to the plan and you must receive prior authorization from the plan in order for the services related to the second condition to be covered.

Please note: For the period of time that you are authorized treatment with the Peace of Mind Program provider for a particular condition, the Peace of Mind Program provider may order X-rays, laboratory tests and other tests to evaluate that condition without prior authorization if these services would normally be covered and would require no prior authorization when ordered by a plan provider. All inpatient care or inpatient, outpatient, or office-based surgery requires prior authorization from the plan. For a list of services requiring prior authorization, see Obtaining specialty care and services. Note that all high-tech radiology services and genetic testing require prior authorization.

If you need physical therapy or occupational therapy for the same condition for which your Peace of Mind Program specialist is treating you, your Peace of Mind Program specialist may refer you for such physical therapy or occupational therapy up to the benefit maximum without prior authorization at the Peace of Mind Program facility, or you may return to a plan therapist if you want.

You may use the Peace of Mind Program for all specialty care except mental health, substance abuse, chiropractic services, obstetrics, speech therapy and infertility services. You may not use the Peace of Mind Program for any primary care services, including internal medicine, family practice or pediatrics. If you have not met the conditions listed above, or if you or your physician have not obtained prior authorization for a Peace of Mind Program service, the services will not be covered by the plan and the Peace of Mind Program provider may hold you financially responsible.