Who is Magellan?
Magellan1 is a trusted leader in the mental health and substance use disorder industry with over 50 years
of experience providing innovative, impactful services to people around the country.
Why is Sharp Health Plan partnering with Magellan?
Sharp Health Plan is partnering with Magellan to ensure our members have access to best-in-class mental health and
substance use disorder services that are rooted in high-quality and compassionate care. This exciting new
partnership will increase the mental health and substance use disorder provider network for our members, connect
them with 24/7 access to personalized, evidence-based digital tools, wellness resources, and much more.
When will this partnership be effective?
The scheduled effective date for this new partnership is Jan. 1, 20242.
Will this change be applicable to my benefit plan?
Magellan will be providing mental health and substance use disorder services for all Sharp Health Plan members,
across all benefit plans including our employer group plans, individual and family plans, and Medicare Advantage
plans.
Will my mental health and substance use disorder benefits change? What about my copays?
No. Your plan benefits for mental health and substance use disorder services will not change, and your costs for
accessing these services will remain the same.
Will this change impact my pharmacy benefits for mental health and substance use disorder medications?
No. There will be no change to your pharmacy benefits through OptumRx for mental health and substance use disorder medications.
Will I need a new member ID card?
No. You will not need a new member ID card.
Can I keep my current mental health and substance use disorder provider?
To receive your plan benefits, you must see a in-network mental health and substance use disorder provider. If your
current provider is part of the Magellan network, you will be able to continue seeing them. If your provider is not
part of the Magellan network, Magellan will give them a chance to join. If your provider chooses to join the
Magellan network, you will be able to continue seeing them. If your provider chooses not to join the Magellan
network, you can select a new provider that is in network or request continuity of care with your current provider.
Please note, if you are enrolled in a POS plan, you will be able to keep your provider on the Tier 2 or Tier 3
level.
How will I know if my provider is in the Magellan network?
If you have accessed mental health and substance use disorder services in 2023, we will send you a letter letting you
know if your current provider is in the Magellan network or not. If they aren’t in the network, we’ll share
additional information with you to ensure you are able to continue accessing care.
What is continuity of care?
To receive your plan benefits, you must see an in-network mental health and substance use disorder provider. Please
note, if you are enrolled in a POS plan, you will be able to keep your provider on the Tier 2 or Tier 3 level.
If your provider chooses not to join the Magellan network, you can contact Magellan at 1-866-512-6190
beginning Dec.
15, 20232, to request continuity of care. Magellan must approve continuity of care prior to
receiving such services.
If your request is approved, you will be able to continue seeing your provider until your care is completed or can
be safely transferred to an in network mental health or substance use disorder provider. Continuity of care may be
provided for the completion of care when you are in an active course of treatment for one of the following
conditions:
| Condition |
Length of Time for Continuity of Care |
| Acute condition |
Duration of acute condition |
| Serious chronic condition |
No more than 12 months from the date of their provider’s contract termination
with Sharp Health Plan
|
| Maternal mental health condition |
12 months from the maternal mental health condition diagnosis or from the end of
pregnancy, whichever occurs later |
Your requested mental health and substance use disorder provider must agree to provide continued services to you,
subject to the same contractual terms and conditions that the provider had in their contract with Sharp Health Plan.
If your provider does not agree, Sharp Health Plan is not required to provide continuity of care.
How do I find a new mental health and substance use disorder provider?
Beginning in January2, you can search Magellan’s online provider
directory. You can filter by specialty, location and more to find the best fit for you.
Do I need a referral to switch mental health and substance use disorder providers?
No. You don’t need a referral or prior authorization to access outpatient therapy from a provider in the Magellan
network. After you choose a provider, contact their office to schedule an appointment as a new patient. Some
services, such as electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), psychological testing,
partial hospitalization and intensive outpatient programs, will require a referral and prior authorization. Please
note that if you have already received a referral and prior authorization by Sharp Health Plan for mental health and
substance use disorder services, a new referral and request for prior authorization for the approved services and
timeframe is not needed to access these services through a provider in the Magellan network.
Do I need a referral to switch applied behavior analysis (ABA) providers?
No, you don’t need a referral or prior authorization to access outpatient therapy from a provider in the Magellan
network. For any new ABA services, your provider will need to request prior authorization from Magellan. Please note
that if you have already received a referral and prior authorization from Sharp Health Plan for ABA services, a new
referral and request for prior authorization for the approved services and timeframe is not needed to access these
services through a provider in the Magellan network.
Who should I contact with questions?
If you have questions, please contact Customer Care at 1-844-483-9013.