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Insurance Plans - Massachusett
Select the name of your insurance company to find out where to get forms
and to find contact information for your plan if you need to request prior
authorization or an exception.
This information was collected from the Web sites of the plans, and in
some cases from e-mails and phone calls to the plans. It is provided here
in an effort to make the information more conveniently available to you.
We do not endorse any particular plan and we are not responsible if any
plan has been inadvertently omitted from this list. We have not verified
this information. In addition, we cannot be responsible for ensuring that
the information is always up to date. Please notify
us if you are aware that any of the information provided has changed.
If you would like more detailed and current information, we suggest that
you consult the Medicare
Web site.
AETNA HEALTH INC
AMERICAN PROGRESSIVE LIFE AND HEALTH INS CO NY
Where to Get Forms: Call 1-800-244-5800 and ask to have from sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com
Updated: May 2006
BLUE CROSS & BLUE SHIELD OF MA HMO BLUE, INC.
Where to Get Forms: Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicareDHPMS@express-scripts.com
Updated: May 2006
CENTRAL NEW ENGLAND JOINT ENTERPRISE
COMMONWEALTH CARE ALLIANCE, INC.
Where to Get Forms: Call 1-866-610-2273 and ask to have form faxed.
Phone # to request Prior Authorization: 1-866-610-2273
Phone # to request Exception: Not Available
Fax #: 617-426-1311
E-mail Address: nroach@commonwealthcare.org
Updated: May 2006
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
COVENTRY HEALTH AND LIFE INS COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number.
E-mail Address: Not Available
Updated: May 2006
FALLON COMMUNITY HEALTH PLAN
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: jroesch@pharmacare.com
Updated: May 2006
FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY
Where to Get Forms:
Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number.
E-mail Address: Not Available
Updated: May 2006
HARVARD PILGRIM HEALTH
CARE
Where to Get Forms:
Call 1-800-788-2949 and as to have form sent.
Phone # to request Prior Authorization: 1-800-788-2949 Option
3
Phone # to request Exception: 1-800-788-2949 Option 3
Fax #: 858-790-7100
E-mail Address: Robert.Horn@MedImpact.com
Updated: May 2006
HEALTH NET LIFE INS
CO/HEALTH NET INS OF NY
HUMANA HEALTH PLAN,
INC.
MEDCO CONTAINMENT INSURANCE
COMPANY OF NEW YORK
Where to Get Forms:
Your pharmacist will receive information from the plan if your prescription
is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will
receive information from the plan if your prescription is denied because
of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: Not Available
Updated: May 2006
MEMBERHEALTH, INC.
PACIFICARE LIFE AND
HEALTH INSURANCE COMPANY
PENNSYLVANIA LIFE INSURANCE
COMPANY
Where to Get Forms:
Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com
Updated: May 2006
RXAMERICA, LLC
Where to Get Forms:
Call 1-866-772-7737 for fax on demand automated phone service.
Phone # to request Prior Authorization: 1-866-549-0991
Phone # to request Exception: 1-866-549-0991
Fax #: 1-866-855-2676
E-mail Address: lois.mastin@rxamerica.com
Updated: May 2006
SENIOR WHOLE HEALTH,
LLC
SILVERSCRIPT INSURANCE
COMPANY
STERLING LIFE INSURANCE
COMPANY
TUFTS ASSOCIATED HMO,
INC.
UNICARE
UNITED AMERICAN INSURANCE
COMPANY
Where to Get Forms:
Your pharmacist will receive information from the plan if your prescription
is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will
receive information from the plan if your prescription is denied because
of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com
Updated: May 2006
UNITED HEALTHCARE INSURANCE
COMPANY
Where to Get Forms:
Call 1-877-665-6630 and ask to have form sent.
Phone # to request Prior Authorization: 1-877-665-6630
Phone # to request Exception: 1-800-207-2589
Fax #: 1-866-617-6706
E-mail Address: provider.relations@walgreens.com
Updated: May 2006
WELLCARE HEALTH PLANS
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