Approvals and Referrals
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.
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.