Your plan for better healthSM1

Authorization of services

What is authorization?

Since some medical services require authorization from your plan, we evaluate the medical necessity for some of the following health-related services:

  • Behavioral health and substance abuse
  • Inpatient hospital admission
  • Prescription drug approvals
  • And other services

You can learn more about authorization, member responsibilities and authorization exceptions in the Service Benefit Plan brochure or by calling Customer Service at 1-800-222-4739.

Behavioral health and substance abuse

Authorization is required for all mental health and substance abuse services. To obtain authorization, you, your physician, your hospital or someone acting on your behalf must contact Magellan Health Services at 1-800-288-3976 before you begin treatment.

Inpatient hospital admission precertification

Before a member is admitted to a hospital for inpatient services, the medical necessity of the proposed stay, procedures or services that are to be performed and the number of days needed to treat your condition must be evaluated. To learn more about precertification, member responsibilities and precertification exceptions, review the Service Benefit Plan brochure or call Customer Service at 1-800-222-4739.

Prescription drug approvals

Certain prescription drugs require authorization. Refer to your Service Benefit Plan brochure for more information or call Customer Service at 1-800-222-4739. You can also call the Retail Pharmacy Program at 1-800-624-5060 for additional information about member responsibilities concerning prescription drugs that require authorization.

Other services

Please call 1-800-222-4739 for assistance with:

  • Organ/Tissue Transplants
  • Hospice
  • Certain Outpatient Surgical Services

Not sure about next steps?

Do you have additional concerns about your health? Not sure what to do next?

Call .
What members are saying

"My health coach was an excellent motivator. She offered practical ways in which I could improve my physical and mental health."

"My health coach was very good and helped me a lot with managing my condition."

"My case manager was excellent. I knew I was in good hands and that she cared."

"We were completely surprised by the first call by the case manager before surgery. She was very helpful and fully explained the process even better than the doctor."

Read more testimonials and other important news in our newsletters.