*** If you are in crisis or considering suicide, or if you or someone you know is currently in danger, please dial 911 immediately. ***

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Navigating treatment for behavioral health conditions can be challenging, and we are here to help. If you’re unsure of where to start, our clinical experts are here to listen, help and guide. Sometimes it helps just to start asking questions. 

If you'd prefer to do some research on your own before talking with us, you can visit the provider search portal to view Behavioral Health providers and facilities in our network.

FREQUENTLY ASKED QUESTIONS

What is the difference between the Employee Assistance Program (EAP) and behavioral health benefits?

EAP is available to all staff and their household members. EAP offers access to no-cost counseling - up to eight (8) visits per issue.  You do not need to be enrolled in a Michelin’s medical plan to use these no-cost services.  You may elect to use counseling services before starting outpatient treatment.

Review EAP services in Explore

Behavioral health benefits are available to you as the subscriber and your covered dependents on your company’s Magellan plan.  These benefits are a part of your overall medical plan.   

Services include:

• Inpatient Care
• Intensive Outpatient Programs
• Partial Day Treatment
• Detoxification and Substance Abuse Treatment
• Residential Treatment
• Medication Evaluation and Management with a Psychiatrist or Mental Health Nurse Practitioner
• Outpatient Treatment for individuals, family or groups with Psychologists, Licensed Professional Counselors, and Licensed Clinical Social Workers

To access these benefits please call Magellan at 1-800-537-5221 (press 1, then press 2).

Who is eligible to use behavioral health benefits?

Behavioral health benefits are available to you as the subscriber and your covered dependents on your company’s Magellan plan. 

Is there a cost for these services?

Typically, co-insurance or copayments and/or annual deductible and out-of-pocket costs.

What should I do when detoxification or rehabilitation services are needed?

When it comes to drug and alcohol addiction, we understand that it’s difficult to manage a situation where you or a loved one need to admit there is a problem and seek help.

If you (or a loved one) have an addiction and want to get sober please give us a call at 1-800-537-5221  (press 1, then press 2) to speak with a clinician for assistance in finding an in-network facility. Using in-network services will reduce your out-of-pocket costs.

What services require pre-authorization? 

• Pre-Authorization is not needed for routine outpatient therapy or medication evaluation and management with a Psychiatrist or Mental Health Nurse Practitioner
• Pre-Authorization is required for non-routine outpatient care (psychological testing, ECT, ABA services for Autism, etc.)
• This includes both in-network and out-of-network providers and facilities.
• Pre-Authorization is required for all higher levels of care including Intensive Outpatient, Partial Hospitalization, Residential Treatment and Inpatient Hospital care.
• This includes both in-network and out-of-network providers and facilities.

If you have questions about whether treatment requires pre-authorization, please call 1-800-537-5221 (press 1, then press 2) for assistance.  We can also help you find an in-network counselor, psychiatrist or facility.

What is therapy?

A therapist is a licensed mental health professional who helps clients improve their lives, develop better cognitive and emotional skills, reduce symptoms of mental illness and cope with various challenges. Therapy is a time-tested tool that helps people with a variety of issues including anxiety, depression, grief, relationship problems, self-exploration, stress, substance abuse, trauma and more.

There are many misconceptions about what it means to talk to a licensed professional and the stigma associated with it is often the reason people don’t seek help in the first place. However, therapy can help people manage issues, develop coping skills and improve their quality of life.

What is the difference between in-network and out-of-network providers?

An in-network provider is one that is contracted with Magellan to provide services to plan members for specific pre-negotiated rates. An out-of-network provider is one not contracted with Magellan.

Typically, if you visit a physician or other provider within the network, the amount you will be responsible for paying will be less than if you go to an out-of-network provider. Though there are some exceptions, in many cases, Magellan will either pay less or not pay anything for services you receive from out-of-network providers.

An additional benefit of in-network providers is that they will file claims on your behalf.  If you choose to use an out-of-network provider, your out-of-pocket costs will typically be much higher, and you may have to pay up front for services and file claims with Magellan for reimbursement.

How do I submit a claim?

In-network providers

• When you use an in-network provider, they will submit the claim directly to Magellan on your behalf.
• If you receive a Magellan referral, your provider will complete and submit the appropriate claim form to be reimbursed for your care.
• You do not need to submit a claim or call for outpatient authorization.

Out-of-network providers

• Out-of-network providers are not required to process and submit your claims. 

How do I file a complaint or appeal?

Complaint

If you have a complaint about the care or services you received, please call Magellan directly.

Magellan uses First Call Resolution to resolve concerns at the time of each member’s call; however, if you are not satisfied with the outcome you may submit complaints verbally or in writing.

Complaints are acknowledged within 24 business hours and resolved within 30 calendar days.

Call 1-800-537-5221 (press 1, then press 2)

Write:

Magellan Health Services
Attention: Complaints/MO41
14100 Magellan Plaza
Maryland Heights, MO 63043

Appeal

You have the right to request Magellan to review the denial or payment of any claim. When a claim is denied the correspondence to the member includes information about the limits for each stage of the appeal.

Appeals must be initiated within 60 days of Magellan’s denial of your initial claim and the limits outlined in the correspondence must be adhered to.

Magellan will have previously reviewed your medical records for any claim requiring a medical determination. If Magellan denies a claim for medical reasons, you may request verbally or in writing that Magellan review the claim.

If you are not satisfied with the results of the review, you may file a written appeal to Magellan. The appeal must be written and include your full name, the enrollee’s identification number (indicated on your membership card), the date of the service, the name of the provider for whose services payment was denied, and the reason you think the claim should be paid. You are responsible for providing Magellan with all information necessary to review the denial of your claim. Magellan will review your appeal and respond within 60 days of Magellan’s receipt of all information necessary to make a decision.

Administrative and Clinical appeals

Magellan Appeals Department
P.O. Box 2128
Maryland Heights, MO 63043

Fax Number: 1-888-656-3820

Members needing assistance in filing Appeals: 1-800-201-3957

Get started with the Digital Emotional Wellbeing program

No matter where you are on life’s journey, the Digital Emotional Wellbeing program by NeuroFlow empowers you to live better with relaxation and mindfulness techniques, strength-building activities, behavior tracking and wellbeing assessments. Complete activities such as breathing exercises, meditation, yoga or journaling. Track mood, sleep, stress and pain, and see your progress over time. Complete confidential, self-paced digital cognitive behavioral therapy modules for anxiety and depression. Sync with other trackers like Fitbit, Garmin and MyFitnessPal through Apple Health or Google Fit.

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