within three calendar days after we receive the request. If the request was received orally or in writing and is denied, we will send a letter to you within five calendar days after we receive the request. The decision letter will explain the reason for the determination along with instructions for filing an appeal. You may request a copy of the complete Utilization Review criteria used to make the determination by calling Member Services. Your PCP or Participating Provider will request authorization when necessary. The following are examples of Services that require prior, concurrent, or post-service authorization:  Acupuncture Services (physician referred). The initial evaluation and management visit and up to six treatment visits in a New Episode of Care do not require authorization.  Bariatric surgery Services.  Breast reduction surgery.  Drug Formulary exceptions.  Durable Medical Equipment.  External Prosthetic and Orthotic devices.  Gender Affirming Treatment.  General anesthesia and associated hospital or ambulatory surgical facility Services provided in conjunction with non-covered dental Services.  Habilitative Services.  Hospice and home health Services.  Inpatient hospital Services, including birthing centers.  Inpatient and residential Substance Use Disorder Services.  Inpatient, residential, and Assertive Community Treatment (ACT) mental health Services.  Non-emergency medical transportation.  Open MRI.  Plastic surgery.  Referrals for any Non-Participating Facility Services or Non-Participating Provider Services.  Referrals to Specialists who are not employees of Medical Group.  Rehabilitative therapy Services. The initial evaluation and management visit and up to six treatment visits in a New Episode of Care for physical, massage (soft tissue mobilization), occupational, and speech therapies do not require authorization.  Routine foot care.  Skilled nursing facility Services.  Spinal and Extremity Manipulation Therapy Services (physician-referred). The initial evaluation and management visit and up to six treatment visits in a New Episode of Care do not require authorization.  Organ transplant Services.  Transgender Surgical Services.  Travel and lodging expenses. If you ask for Services that the Participating Provider believes are not Medically Necessary and does not submit a request on your behalf, you may ask for a second opinion from another Participating Provider. You EWCLGHDHP1983ACT0124 33 WAPEBB-CD-ACT