May 29, 2008

Updated Prior Authorization List For PPO Health Plan Members

Effective July 1, 2008, the list of medical services that require Prior Authorization for PPO plans will be updated. We will be communicating soon with PPO health plan members to inform them of this change to their Prior Authorization list. Please see the attached member letter and updated Prior Authorization lists.

If health plan members use participating physicians and providers, there is nothing they need to do. It is the responsibility of the provider to obtain the prior authorization for all medical services and prescription drugs that require prior authorization, before the procedure is performed or the prescription is filled. Physicians and providers have received information on how this process works.

If health plan members use out-of-network physicians or providers, it is the member’s responsibility to obtain prior authorization for medical services and prescription drugs before the procedure is performed or the prescription is filled. If they do not obtain this prior authorization, the reimbursement of their claim may be denied or reduced. When health plan members use participating physicians or providers, there are no additional costs to pay for covered services and prescriptions, other than applicable copayments, coinsurance, or deductibles. The reimbursement for any out-of-network covered services/drugs is subject to all terms of health plan members’ Evidence of Coverage.

Health Net regularly reviews new technologies and services as well as the utilization of covered services across our membership in order to make data-driven decisions regarding what services should require prior authorization.

If you have any questions, please contact your Health Net representative. 

Click here for the member letter.
Click here for the Prior Authorization List for PPO plans in Connecticut.
Click here for the Prior Authorization List for PPO plans in New Jersey.
Click here for the Prior Authorization List for PPO plans in New York.

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