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Frequently Asked Questions Approvals & Referrals
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.
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