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Coverage Information

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 doesn't 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

Prior authorization (or PA for short) means we must approve a service or prescription drug before you can get it. You or your PCP/specialist should contact us to ask for this approval. If we do not approve your request, we'll let you know. Plus, we’ll give you details about how to file an appeal. See your member handbook for the list of services that are covered, and which require a PA.

Staywell Plan Documents

You can see which services require a prior authorization.

How to Get an Authorization

Getting Authorization

Type of Request Decision Time Frame Who Can Request One How to Request
Normal (for non-
emergency care)
Seven calendar days You or your provider Call: 1-866-334-7927
Fax: 1-877-297-3112
Expedited/Fast** 
(for urgent care) 
48 hours  You, your provider  Call: 1-866-334-7927 
Fax: 1-877-297-3112
Say: ‘I’d like an expedited/fast decision”

*Sometimes we may need more time to make a standard decision. This may be because we need more information and it’s in your best interest. If so, we’ll take up to seven more calendar days.

**Sometimes we may need more time to make a fast decision. If so, we’ll take up to two more business days.

Services Available Without Authorization

You do not need approval from us or your PCP for the following services:

  • Chiropractic
  • Dermatology
  • Emergency/urgent care
  • Family planning from any participating Medicaid provider
  • One women’s health visit to an OB/GYN provider each year
  • Podiatry
  • Post-stabilization care

Even though you do not need approval for these services, you will need to pick a network provider. Look through your provider directory to find one.

Don’t forget about our online provider search tool – Find a Provider. When you’ve made your choice, call to set up an appointment. Remember to take your ID card with you.

  • Getting Authorization

    Getting Authorization

    Type of Request Decision Time Frame Who Can Request One How to Request
    Normal (for non-
    emergency care)
    Seven calendar days You or your provider Call: 1-866-334-7927
    Fax: 1-877-297-3112
    Expedited/Fast** 
    (for urgent care) 
    48 hours  You, your provider  Call: 1-866-334-7927 
    Fax: 1-877-297-3112
    Say: ‘I’d like an expedited/fast decision”

    *Sometimes we may need more time to make a standard decision. This may be because we need more information and it’s in your best interest. If so, we’ll take up to seven more calendar days.

    **Sometimes we may need more time to make a fast decision. If so, we’ll take up to two more business days.

  • Services Available Without Prior Authorization

    Services Available Without Authorization

    You do not need approval from us or your PCP for the following services:

    • Chiropractic
    • Dermatology
    • Emergency/urgent care
    • Family planning from any participating Medicaid provider
    • One women’s health visit to an OB/GYN provider each year
    • Podiatry
    • Post-stabilization care

    Even though you do not need approval for these services, you will need to pick a network provider. Look through your provider directory to find one.

    Don’t forget about our online provider search tool – Find a Provider. When you’ve made your choice, call to set up an appointment. Remember to take your ID card with you.

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Last Updated On: 6/28/2016
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