Important plan information for current participants
Member Handbook/Enrollment Agreement
The Enrollment Agreement is a booklet you receive when you join Fallon Health Weinberg-PACE. It explains the benefits you may receive and how to use them. It will also tell you what's covered, how to make a complaint, how to disagree with or appeal any decision that is made about your health care, and your rights and responsibilities if you choose to leave the plan. It also tells you about your prescription drug coverage.
Forms
Fallon Health Weinberg-PACE is dedicated to protecting privacy. We're strict about who can see member information. However, there may be times when members want to allow certain people (like a caregiver) to see their information. You can use the forms below to grant or deny access to member information.
Appointment of Representative form - PACE (PDF)
Identify a personal representative who Fallon Health Weinberg can release your personal information to. This form may also be used to appoint someone to handle a grievance or coverage determination, or to deal with any level of the appeal process. Return the completed form to:
Fallon Health
Attn: Privacy Coordinator
1 Mercantile St., Ste 400
Worcester, MA 01608
Amendment Request for Personal Information form (PDF)
Request changes to a member record if you think it's inaccurate or incomplete. This form isn't required for corrections to address, date of birth, or name.
Veteran's Office Authorization for Release of Personal Information form (PDF)
Allow a veteran's office to receive your personal information from Fallon Health Weinberg-PACE.
Request for an Accounting of Disclosures of Personal Information form (PDF)
Request a listing of who Fallon Health Weinberg has shared your information with for reasons other than treatment, payment, or health care operations.
Restrictions form (PDF)
Request a limit on how we use or share your personal information.
Filing an appeal or grievance
You can find information about grievance, coverage determination, and appeal processes in your Enrollment Agreement. Please check the section called "Participant Appeal Process."
You can also find information about your rights and responsibilities as a member of Fallon Health Weinberg-PACE in your Enrollment Agreement. Please check the section called "Participant Rights."
To file an appeal, you can:
- Call Member Appeals and Grievances at: 1-800-333-2535, ext. 69950 (TRS 711), or
- Mail, fax, , email, or deliver your written appeal request to:
Fallon Health Weinberg-PACE
Attn: PACE Program Director
461 John James Audubon Pkwy.
Amherst, NY 14228
Fax: 1-716-250-3160
Email: grievance@fallonhealth.org
If calling about the status, or if you have questions about the appeal process, please call the number above. They’re available Monday through Friday, 8 a.m. to 6 p.m.
To file a grievance, you can do so:
- By telling a staff member
- By sending a letter that includes all the details of your grievance to:
Fallon Health Weinberg-PACE
Attn: PACE Program Director
461 John James Audubon Pkwy.
Amherst, NY 14228
- By calling 1-855-665-1113 or 1-716-810-1895 (TTY 711), 8 a.m. to 5 p.m., Monday through Friday.
If calling about the status, or if you have questions about the grievance process, please call the number above.
More information about the appeal and grievance process is available in these documents: How to file an appeal (pdf) and How to file a grievance/complaint (pdf)
Privacy and protection
Fallon Health Weinberg-PACE protects your personal health information. It can only be used for official reasons.
About HIPAA ► Our website privacy policy ►
All services must be provided by or authorized by the PACE Interdisciplinary Team (except emergency services). PACE participants may be held liable for costs for unauthorized or out-of-PACE program agreement services.
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The information on this page was last updated on 5/19/2026.