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Prior Authorizations and Referrals

Medical and Behavioral Health Care Services

When you need health care, always start with a call to your medical or behavioral health provider. You can choose any provider in our behavioral health network. You don’t need a referral from your primary care provider (PCP).

Prior Authorization and Referrals

Some covered services or medications may need approval from Magnolia Health, and this is called a Prior Authorization. You do not need a paper referral from Magnolia Health to see a provider but your provider may need to request a prior authorization from Magnolia Health for a service to be approved. Below is a list of services that require prior authorization from Magnolia Health before your healthcare provider can proceed with treatment.

Inpatient Hospitalization

Pre-scheduled, optional services must be approved by Magnolia Health before you are admitted. Your provider will send a request to Magnolia Health.

How soon can I expect to be seen by a specialist?

In some situations, the specialist may see you right away. Depending on the medical need, it may take up to 30 days to schedule the appointment to see the specialist.

How do I ask for a second opinion?

You have the right to a second opinion from a Magnolia Health provider if you are not satisfied with the plan of care offered by the specialist. Your primary care healthcare provider should be able to give you the name of a provider for a second opinion visit. If your primary care provider wants you to see a specialist that is not a Magnolia Health provider; that visit will have to be approved in advance by Magnolia Health.

Non-Participating/Out-of-Network Providers

Requests for services from a provider, facility, or vendor that is not in the Magnolia Health network need to be approved by getting a prior authorization.

Your healthcare provider can tell you if a medical service or prescription needs prior authorization. The list below gives you general categories of services requiring prior authorization. Please keep in mind that services and benefits change from time to time. This prior authorization list is for your general information only. Please call Magnolia Health Member Services for the most up to date information at 1-866-912-6285 (Relay 711).

Magnolia Health Services that require a Prior Authorization.



Durable Medical Equipment (DME)

Some items require prior authorization.

High Cost Radiology


Home Health Care Services


Hospice Care


Hospital Services Inpatient


Hospital Services Outpatient

Some services require prior authorization.

Laboratory Services:  All services necessary for the diagnosis, treatment and prevention of disease, and for the maintenance of health.

Some services require prior authorization.

Pain Management

Some services require prior authorization.

Substance Use Disorder Services

Some services require prior authorization.

Therapy (OT, PT,ST) Services (Outpatient)


Transplant Services