FAQs

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Approvals & Referrals

What services require prior approval or a referral?

How do I get prior approval or a referral?

What if I don't get prior approval or a referral?

When do I need a referral from my primary care provider (PCP)?

Q: What services require prior approval or a referral?
A: Answers vary according to plan. For more information, please visit the FAQs on your plan's Member page.

Q: How do I get prior approval or a referral?
A: Answers vary according to plan. For more information, please visit the FAQs on your plan's Member page.

Q: What if I don't get prior approval or a referral?
A: If you do not receive prior approval or certification for services (except emergency care or maternity), your claim may be denied, paid at a lower benefit, or a penalty may be applied.

Q: When do I need a referral from my primary care provider (PCP)?
A: You do not need to get a referral from your primary care provider to receive covered services from a participating specialist. However, some participating specialists may require a new patient introduction from your treating doctor.

Services for mental health and substance abuse must be approved in advance by Magellan Behavioral Health.