Call your PCP when you need regular care. He or she will send you to see a specialist for tests, specialty care and other covered services that he or she does not provide. Be sure your PCP approves you to see a specialist. We will cover this care. If your PCP does not provide an approved service, ask him or her how you can get it.
Prior authorization means we must approve a service before you can get it. Your PCP or specialist will contact us to ask for this approval. If we do not approve the request, we will let you know. We will give you information about our appeals process and your right to a Medicaid Fair Hearing, if you are eligible, and do not agree with our decision.