What Magellan Health Is
Magellan Health is not a health insurance company in the traditional sense. It is a managed behavioral health organization — a company that employers and insurance carriers hire to manage the behavioral health (mental health and substance use) portion of their benefits. This is called a "behavioral health carve-out."
What this means for you:
- Your medical insurance may be through Aetna, UHC, or another carrier
- Your behavioral health benefits may be managed separately by Magellan
- Authorization for substance use treatment goes through Magellan, not your medical carrier
- The benefit levels are set by your employer, not by Magellan
What Magellan-Managed Plans Generally Cover
Plans managed by Magellan typically cover the full continuum of substance use disorder treatment:
- Medical detox — covered when medically necessary
- Residential rehab — covered for clinically appropriate stays, authorized in increments
- Partial hospitalization (PHP) — covered as step-down or primary care
- Intensive outpatient (IOP) — widely covered
- Standard outpatient therapy — covered under behavioral health benefits
- Medication-assisted treatment (MAT) — generally covered
Because benefit levels are set by the employer, coverage can vary more than with standard insurance products. Verification is especially important.
How Magellan Authorization Works
Magellan uses its own clinical criteria to evaluate treatment authorization:
- Pre-authorization: we contact Magellan with clinical information to request authorization for the appropriate level of care
- Initial authorization: typically 5-7 days for detox, 7-14 days for residential
- Continued stay review: at each authorization endpoint, we submit updated clinical documentation
- Step-down planning: Magellan expects documented transition planning throughout the stay
Our clinical team is experienced with Magellan clinical review standards and documentation requirements.
In-Network vs. Out-of-Network
BetterChoice works with Magellan-managed plans both in-network and out-of-network:
- In-network: contracted rates, lower out-of-pocket costs
- Out-of-network: coverage depends on the specific employer plan; many plans cover OON at reduced rates
- Single case agreement (SCA): we negotiate one-time agreements with Magellan when standard in-network access is not available
How to Know If You Have Magellan
Check your insurance card for:
- "Magellan Health" or "Magellan Behavioral Health" printed on the card
- A separate behavioral health card in addition to your medical card
- A Magellan member services phone number
If you are unsure, call us with your insurance information and we will determine whether Magellan manages your behavioral health benefits.
How to Verify Benefits
Call us at (725) 550-5655 with:
- Your Magellan member ID (or your medical insurance member ID)
- Group number
- Date of birth
- Your medical insurance carrier name (if different from Magellan)
We verify benefits within about ten minutes and call you back with confirmed coverage, estimated costs, and next steps. No commitment.
Contact
(725) 550-5655 198 Ebb Tide Cir Las Vegas, NV 89123