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REFERRALS
Your PCP may refer you to other providers to get special services. A referral is
when your PCP sends you to a specialist for a specific problem. A referral can also
be to a lab or hospital, etc. Mercy Care Plan may need to review and approve certain
referrals and special services first before you can go get the services. Your PCP
will know when to get Mercy Care Plan's approval. If your referral needs to be approved
by Mercy Care Plan, your PCP will let you know what's happening.
You may also request a second opinion from another Mercy Care Plan doctor.
AUTHORIZATIONS
An authorization is an approval from Mercy Care Plan for you to get the special
services your PCP has referred you to. Mercy Care Plan may take up to 14 days to
approve a routine authorization request and three (3) business days to approve an
urgent request. If Mercy Care Plan does not receive all the necessary information
to authorize the request, a 14 day extension may be requested. If you have questions
about whether your service has been authorized, call your PCP. You do not need approval
from Mercy Care Plan to get emergency services.
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