Your Fallon Senior Plan™ Referral

Pre-Fitting information:

1. Patient is referred to clinic and appointment is scheduled
2. Amplifon verifies insurance benefits
3. Provider informs patient of the copay - $695, $795 or $995 dependent on product pricing tier
4. Fallon Senior Plan patients can purchase a higher priced hearing aid(s), however, the difference between their copay and the  device cost becomes the patient's out-of-pocket responsibility. 
5. Disclosure form is provided by Amplifon and must be reviewed with Fallon Senior Plan patient prior to fitting.
6. Provider recommends hearing aid(s) and orders from the manufacturer using the appropriate Amplifon bill-to number and your ship-to address. Please reference the PO reference number located on the Receipt of Delivery form. Amplifon pays the manufacturer for hearing aids and earmolds under this plan.

Fitting and Payment:

1. Hearing aid(s) must be fit by a contracted Fallon Senior Plan professional.
2. Patient pays full invoice amount. Payment to Amplifon may be made via e-check or credit card through the provider portal, or through Care Credit and must be forwarded to Amplifon. If patient cannot pay by e-check, credit card, or Care Credit, then payment by check will be accepted. Checks should be made payable to Amplifon Hearing Health Care.
3. Please send the signed Receipt of Delivery and Disclosure forms along with the Packing Slip from the manufacturer to Amplifon Hearing Health Care within 24 hours of fitting.

• 2 year free supply of batteries with every purchase.
• The first year supply of batteries will be mailed to the customer’s home, along with a reminder letter to contact Amplifon for their second year of free batteries.
• After their two year supply is depleted, the customer may contact Amplifon to find out if additional battery coverage is available.

• Amplifon Hearing Health Care must have a completed W-9 from you in order to process your dispensing fee. 
• You will be paid 60 days after the delivery date. Standard dispensing fees apply.

If you have any questions regarding our partnership with Fallon Senior Plan serving Medicare Advantage members in your area, don’t hesitate to call Amplifon at 1-800-920-4327.