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For Members

Appeals *

What is an appeal?

An appeal is a formal request to Magellan.  It asks for a review of a decision about your behavioral health services.

You have the right to ask for a review of the following:

  • Denial of a service you or your provider asked for
  • Decrease in a service
  • End or suspension of a service
  • Denial of payment for a service
  • Failure to provide services fast enough
  • Failure of Magellan to act within time limits to solve an appeal or grievance
  • Denial of a request for services outside of the provider network. This applies when you cannot get needed services within the network.

How do I file an appeal?

If you need help sending an appeal, call Magellan at 1-800-424-4489 or TTY 1-800-424-4416 and tell the person who answers the phone that you want to file an appeal.

Can I file a written appeal?

You can also file a written appeal using our Member Appeal Form.

Mail, email, or fax your request and any supporting papers to:

Magellan Health Services
Attn: Appeals & Grievances
P. O. Box 83680
Baton Rouge, LA 70884-3680

Email:  LACSoCAppeals@magellanhealth.com 

Fax:   Toll-free 1-888-656-4102

Within 3 days of your request, Magellan will let you know in writing that we got your appeal.

Where can I find more about appeals?

Your Coordinated System of Care (CSoC) Member Handbook (pages 8-10) can answer more questions about appeals like:

  • What is an expedited appeal?
  • What happens after I file an appeal?
  • How is my appeal resolved?
  • What if I am not happy with my appeal results?
  • How do I ask for a State Fair Hearing?
  • What is the process for my State Fair Hearing?
  • How is my State Fair Hearing resolved?
  • Will my services continue during the Appeal or State Fair Hearing?

 

* If you’re helping someone who does not speak English, call the number above.  We will make sure they get help in their own language for free.

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