You’ve got questions, we’ve got answers. If there’s a question you can’t find the answer to on our website, call Member Services at 866-606-3700 (TTY 711).
Meridian is a Medicaid managed care plan that partners with the State of Illinois to provide services for Illinois Medicaid beneficiaries through the HealthChoice Illinois program.
If you are eligible for Medicare, you may be eligible in MeridianCare. For more information on our dual-eligible program, please visit MyMeridianCare.com.
You can become a Meridian member if you are enrolled in the Illinois Medicaid program and eligible for services under HealthChoice Illinois. For more information click here.
A Primary Care Provider (PCP) is a licensed physician, nurse practitioner, clinical nurse specialist or physician assistant, as allowed under state law, who provides and manages your health care services. This can also be called a Primary Care Physician.
Your primary care provider is the person you see first for most health problems. They make sure that you get the care you need to keep you healthy. They also may talk with other doctors and healthcare providers about your care and refer you to them.
Use our Provider Search tool to locate a provider near you. You can also call our Member Services Department at 1-877-902-6784 (TTY: 711), Monday - Sunday from 8 a.m. – 8 p.m.
No, you do not need a referral from your PCP to see a specialist. You do not need a referral for routine vision care, chiropractic services, or mental health/counseling services.
No, Meridian does not charge co-pays for any covered services.
Yes, Meridian does offer help with transportation. Please refer to your Member Handbook for more information. You can schedule your gas reimbursement up to 30 days BEFORE your appointment date. The earlier you let us know about your transportation needs, the better we can help you. We may also be able to provide alternative methods of transportation based on needs or medical necessity."
Chiropractic services for members under 21 years old are covered and do not require authorization for in-network providers.
Behavioral health is a type of health care that offers mental health and substance abuse counseling.
Call our Behavioral Health Department at 888-222-8041 if you need help finding a behavioral health provider in your area.
No, you do not need a referral from your PCP (Primary Care Provider). MeridianHealth can help you find a provider in your area. Please call our Behavioral Health department at 866-796-1167 if you have questions about whether your service is covered.
Preauthorization is approval from a plan that is required before the plan pays for certain:
- Medical equipment or
This is also called prior authorization, prior approval or precertification. Your plan may require preauthorization for certain services before you receive them. This excludes an emergency.
Prior Authorization is not needed for outpatient behavioral health services from MeridianHealth.
You can reach MeridianHealth's Behavioral Health department Monday through Friday from 7 a.m. to 5 p.m. at 866-796-1167.
If you are having a Behavioral Health crisis or emergency please call 911.
You can ask your behavioral health provider to call MeridianHealth Behavioral Health Department at 866-796-1167 to obtain or verify an authorization is on file.
Yes, as long as your behavioral health provider is part of the MeridianHealth network. To find out if your provider is part of our network, please call 866-796-1167.
If you are currently using an out-of-network behavioral health provider, please call MeridianHealth Behavioral Health Department.
Take your Meridian Member ID Card to the pharmacy. You should also take personal identification, like a driver's license or state issued identification card, with your picture on it.
If you have paid cash for a medication, please fill out the form below and attach the medication label name, pharmacy receipt and a note describing the reasons for paying cash.
A drug formulary is a list of prescription drugs approved by your plan. The Meridian Formulary uses the clinical advice of doctors, pharmacists and other medical experts to come up with this drug list.
A PBM is a business that works with insurance companies to fill member prescriptions.
There may be times when your doctor prescribes a drug for you that is not approved in your plan. Your doctor can fill out a PA request form, giving facts about your medical history and why you need the drug. Note: We must approve the drug before you can fill the prescription.
Meridian may deny a drug request for medical reasons. If your doctor's PA request is not approved, you and your doctor will get a letter explaining why. The letter will also explain the appeal process if you and your doctor disagree with the denial.
For some drugs, there are limits to how much you can take safely. This limit is based on research from the drug maker and the FDA. The QL is the amount of drug that can be filled safely each month. If your doctor feels that you need more of a medication, he/she must fill out a PA request.
Sometimes more than one medication can be used to treat your condition. Step therapy means that one medication must be tried first before another medication can be tried. Your healthcare provider or pharmacist can explain which medication must be tried first.
Please call the Pharmacy Help Desk at 855-580-1688.