Frequently Asked Questions 

Changing your PCP is just one of the many things you can do on our secure, interactive member portal. Log into your account on the member portal at  my.healthnewengland.org. Click on "Change my PCP" in the left hand navigation menu after you log in and follow the prompts. You will be able to search for PCPs who participate in your plan and then select a new PCP.

Or, if you prefer, you can still call Health New England's Member Services at (413) 787-4004 or (800) 310-2835, Monday through Friday, 8 a.m. - 6 p.m., for help.

Is the bill for a copay? A non-covered service? If it is, it's up to you to pay for these.

You can review your claim history and details by logging into your member portal account at my.healthnewengland.org. Just click “Claims” at the top of the page after you log in. From there, you can view claim details and check what claims we have paid.

If you still can't figure out why you got a bill, you can call Member Services at (413) 787-4004 or (800) 310-2835, Monday through Friday, 8 a.m. - 6 p.m.

Whenever your doctor sends you to another doctor, make sure he or she is a Health New England in-plan provider. Log into the member portal at my.healthnewengland.org and search for doctors who participate in your plan by clicking on “Provider Search” at the top of the page.

In the provider search tool, be sure to adjust the search based on the type of plan you are enrolled in (Fully Funded HMO, Medicare Advantage, Be Healthy, etc.).

Or, if you prefer, call Health New England's Member Services at (413) 787-4004 or (800) 310-2835, Monday - Friday, 8 a.m. - 6 p.m.

If you are enrolled in a fully funded plan, all dependents are allowed to remain on your plan until their 26th birthday regardless of whether or not they are married, live with the subscriber or are considered an IRS dependent.

All members are covered for emergency care outside our service area, including foreign countries. If your child is seriously ill or injured and needs immediate medical attention, he or she should call 911 or go to the nearest emergency room right away.

If you are enrolled in an HMO or exclusive plan, please keep in mind that you need to call Member Services at (800) 310-2835 to notify Health New England of emergency services that are not received in a hospital emergency room (for example, at a walk-in clinic or doctor's office.)

All plans include coverage for emergency care outside our service area, including foreign countries. If you’re traveling outside the U.S. and need immediate medical attention, seek treatment right away.

Please follow these guidelines:

• Be sure bills are translated into English.
• Be sure providers convert charges to the U.S. dollar values in effect on the date of service.
• If you are treated at a facility other than a hospital emergency room, please call us at (800) 310-2835 at your earliest convenience to report the services.

You are always covered for emergency care. If you believe you are having a life threatening emergency, call 911 or go to the nearest emergency room.

However, the ER is not usually the best place to go for minor injuries or illnesses. Inappropriate ER visits are a key cause of rising health care costs. ERs are often crowded, and patients are treated based on the severity of their condition. That means you may often have a long wait. ERs also cost much more than the services you get from your primary care provider (PCP) – both for you and your health plan. For example, your ER copay is most likely much higher than your office visit copay.

For non-emergency medical issues, always contact your PCP first. Health New England requires your PCP’s office to have 24-hour phone coverage. That way, if you need care after hours, you can call the office. Your PCP or the physician covering will help you decide what to do—whether you should get care right away or wait to see your PCP..

We also have a 24-hour nurse line, which is a free health information line to help answer your questions whenever they come up. Licensed nurses and clinicians will listen carefully to your concerns and give you information to help you choose the care that’s right for you. The Nurse Line is available 24 hours a day, 7 days a week at (866) 389-7613. Interpretation services are also available for your call. 

In addition, as a Health New England member, you have access to Teladoc® for non-emergency medical issues. If you are ever unable to reach your PCP, you have access to U.S. board-certified physicians 24/7/365 through Teladoc. Learn more at healthnewengland.org/teladoc.

You can view coverage for a specific medication using Health New England's formulary look up tool on healthnewengland.org. Just click "Find A Drug" at the top of the page. You can also find more information by logging into your account on the member portal at my.healthnewengland.org and clicking on “Look up drugs & pharmacies” in the left hand navigation menu.

Please note: Some medications require prior authorization, have quantity limits, or require that you try a less expensive medication before you are able to fill them (a process called step therapy). If your medication is subject to any of these processes, it will be noted on the formulary look up tool. If your provider feels you should have an exception to any of these protocols, there will be a link to the appropriate authorization request form that can be completed and submitted for review.

Flu Shots: Yes, Health New England covers flu shots for all members.

You can also call our Member Services Department at the number listed on your ID card. We are available Monday through Friday, 8:00 a.m. to 6:00 p.m.

If you are an HMO member, all non-emergency services with out-of-plan providers require prior approval. In addition, a limited number of in-plan services require prior approval.

If you are a POS or PPO member, a limited number of services require prior approval.

Log into the member portal at my.healthnewengland.org to see prior approval information specific to your plan.

Remember: For those services that require prior approval, if you get services out-of-plan without prior approval, your coverage may be reduced or denied.

Click here to find medical policies for services that require Prior Authorization, including:

• Health New England medical policies
• MRI/CT and PET Imaging and Genetic Testing
• Durable Medical Equipment
• InterQual Criteria

You have 180 days from the date of denial notice to request a standard or expedited appeal. For urgent care situations, expedited external review may occur at the same time as the internal appeal process.

You may file an appeal. You also may appoint someone to file an appeal for you.  We call this person your authorized representative. The authorized representative may be anyone you choose including an attorney. 

Coordination of Benefits is the process insurance companies use to determine which health plan is primary when an individual is covered by more than one plan and both plans have some responsibility for paying for the same claim.

When a person is covered by two or more plans, Health New England uses the Department of Insurance guidelines 211 CMR 38.04 to determine which plan is primary. The subscriber’s plan is primary in most cases. Contact Health New England’s Coordination of Benefits department for more information (contact information is listed below).

• If you have more than one health insurance plan, we will need to know:
  • Subscriber name and ID number, date of birth, carrier name and effective dates of coverage or termination date.
• If you have Medicare coverage, we will need to know:
  • Subscriber name and ID number, age entitled or disability, and size of the employer group.
• If you have been involved in an automobile, workers compensation or third party accident:
  • Carrier name, claim number, liable party and attorney information.
• If you have an attorney representing you in an automobile, workers compensation or third party accident:
  • Contact COB to provide your attorney’s information.
• If you need to know the type of plan and or if it is an ERISA plan:
  • Provide the member’s name and ID number.

• Other Insurance/Medicare – Subscriber’s name, health carrier information, such as the policy number and the effective date of coverage.
• Automobile/Workers Compensation/Third Party accident – Persons involved in the accident, carrier information, date of loss, attorney information and injury.

The rightinsurance companies have based on your policy to request reimbursement for servicespayable by the at-fault party.

• Telephone:
  • (413) 787-4000, option 2, option 3, option 1
  • Or (413) 233-3314
  • Secure voicemail option available
• Email: cmail@hne.com
  • Note: We process requests in order of date received.
• Fax: (413) 233-2709

Hours of Operations:

Monday through Friday

9:00 a.m. – 12:00 p.m. & 1:00 – 3:00 p.m.