FALLON SURVEY

 
1.

What is the approximate total number of times that you and your dependents have used this plan since January ?
 

If None, Select Button on Left
1-2
3-5
6-10
>10
2.
 Please indicate the reason(s) for having utilized the plan?
 

Routine Checkups
Specialist Visits
Emergency Care
Planned Hospitalization

      Other: Please explain in the Comments field below

 
3.
How would you rate your experience with the Fallon HMO plan with regard to claims processing, plan coverage, extent of network, customer service, etc ?
 

a. Very Satisfied
b. Somewhat Satisfied
c. Somewhat Dissatisfied
d. Very Dissatisfied
4.
 If you answered "c" or "d" to the previous question, please indicate the nature of the problem(s) that you have experienced.
 

Provider not in network
Problem with referral process
Coverage not as expected
Claims not paid in timely manner
Claims denied
Customer Service was not helpful or "knowledgeable

      Other: Please explain in the Comments field below
 
5.
 Approximately how much of your own time was spent on resolving the problems you experienced ?
 

Less than 1/2 hour
1/2 to 1 hour
1 - 2 hours
More than 2 hours
6.
 How were the problems ultimately resolved ?
 

Provider's office handled it.
Assistance from Fallon Customer Service Line
Assistance from HR
Numerous calls and people involved (self, Customer Service, HR, etc.)
Still unresolved
  Send survey to AZ Human Resources.                Clear all fields and start over.